Young Adult E-cigarette Users Research Articles

Discrete Choice Experiment on Financial Incentives for Engaging Young Adults in Vaping Cessation Programs

Introduction Contingency management involves rewarding individuals based on objective evidence of behavioral changes. This study explores preferences for financial incentives in vaping cessation programs. Methods A discrete choice experiment (DCE) was conducted among young adult current e-cigarette users aged 19-29. DCE attributes (and levels) included reward amount ($100, $300), reward schedule (consistent value, escalating value), reward procedure (gain-framed, loss-framed), vaping education modules (yes, no), text messaging support (yes, no), and cost ($30, $100). Participants were randomized into one of the four blocks, each containing four choice sets. Each choice set presented two hypothetical vaping cessation programs. Choice data (n × choice sets × alternative programs = 154 × 4 × 2 = 1,232 observations) were analyzed using generalized estimation equation models. Results Participants showed a preference for vaping cessation programs offering a higher reward amount (odds ratio [OR] = 11.5; 95% CI,7.0-19.2), gain-framed rewards for sustained abstinence (OR = 1.4; 95% CI,1.0-1.8), text messaging support (OR = 1.9; 95% CI,1.4-2.5), and a lower program cost (OR = 2.6; 95% CI,1.8-3.8). Interaction tests showed significant effects of the rewards procedure among daily e-cigarette users (adjusted OR [AOR] = 2.1; 95% CI,1.3-3.5), but not some-day users; and among those with no quit attempts in the past six months (AOR = 2.7; 95% CI,1.5-4.7), but not those with previous quit attempts. Female participants preferred text messaging support (AOR = 3.6; 95% CI,2.3-5.4), whereas male participants did not show this preference. Conclusion A multifaceted vaping cessation intervention augmented with financial incentives might improve participation and engagement among young adults. Future studies should investigate how these attributes can enhance program reach and vaping abstinence outcomes in real-world settings.

Episodic future thinking reduces delay discounting among persons who use e-cigarettes.

There has been an alarming increase in e-cigarette dependence among young adults, many of whom would like to quit vaping nicotine but are finding it difficult to do so. Episodic future thinking (EFT), a cognitive intervention involving imagining future events, has been shown to reduce cigarette craving, demand intensity, and self-administration among cigarette smokers but has not been tested with e-cigarette users. This study tested if a brief EFT intervention decreases delay discounting and smoking choice using a within-subjects experimental design administered via Zoom. Daily young adult e-cigarette users attended a baseline session and two counterbalanced experimental sessions: (a) EFT in which participants preexperienced and described positive future events and (b) standardized episodic thinking, a control intervention in which participants described their experiences watching three short videos. Measures of craving, mood, and delay discounting across three commodities: Money, e-cigarette products, and food were completed pre- and postmanipulation. As predicted, monetary delay discounting showed a greater decrease following EFT relative to standardized episodic thinking (p = .006; ηp² = .229). There were no effects on craving or mood. Participants also completed a 40-min vaping versus money choice task. Approximately 70% of participants chose to abstain for the full 40 min after EFT compared to 60% after the control condition, a nonsignificant difference (p = .184). Additional research is needed to support the efficacy of EFT as an intervention for helping e-cigarette users increase their ability to abstain. The study demonstrates the feasibility of conducting experimental research on e-cigarettes in a virtual setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

E-Cigarette Nicotine Delivery Among Young Adults by Nicotine Form, Concentration, and Flavor

Concerns have been raised about the abuse liability of modern e-cigarettes that use acidic additives to form nicotine salts, making the inhalation of nicotine smoother than freebase nicotine. To examine the effects of nicotine form and concentration and e-liquid flavor on subjective effects ratings, vaping behavior, and nicotine uptake among young adults who use e-cigarettes. In this single-blind, within-participant, crossover randomized clinical trial, a convenience sample of young adults aged 21 to 25 years who currently used e-cigarettes was recruited from December 2021 to August 2023, for in-person research laboratory visits in Columbus, Ohio. Participants completed up to 9 vaping sessions, starting with their usual e-cigarette brand in the first session followed by 1 of 8 laboratory-prepared e-liquids in a randomly assigned order in each subsequent session. Prepared e-liquids varied by nicotine form (salt-based vs freebase), nicotine concentration (5% vs 1% weight per weight), and flavor (menthol vs tobacco). Each session included a 5-minute, 10-puff standardized vaping period followed by 30 minutes of ad libitum vaping. At 4 time points (0, 5, 10, and 35 minutes) during each vaping session, plasma samples were collected for assessing nicotine uptake, and self-reports of urges, craving, and withdrawal were collected via questionnaires. Positive subjective effects were self-reported after 35 minutes of vaping using a visual analog scale; urges and cravings were reported using the Questionnaire of Smoking Urges (QSU). Puff topography data were collected throughout each vaping session. Seventy-two participants (mean [SD] age, 22.4 [1.4] years; 42 [58.3%] female) who sampled at least 1 laboratory-prepared e-liquid composed the analytic sample. Salt-based (vs freebase) nicotine e-liquids increased nicotine intake, with 5% salt-based e-liquids delivering the highest mean plasma levels of nicotine (11.2 ng/mL [95% CI, 9.3-13.2 ng/mL] at 5 minutes; 17.2 ng/mL [95% CI, 14.3-20.1 ng/mL] at 35 minutes) irrespective of flavors. Higher positive subjective effect ratings (eg, for liking) were received by salt-based (42.8; 95% CI, 39.4-46.1) vs freebase (32.0; 95% CI, 28.6-35.3) nicotine, 1% (43.4; 95% CI, 40.2-46.6) vs 5% (31.2; 95% CI, 27.7-34.6) nicotine, and menthol-flavored (43.2; 95% CI, 39.7-46.7) vs tobacco-flavored (31.5; 95% CI, 28.4-34.7) e-liquids. Salt-based and 1% but not menthol-flavored nicotine elicited more intense puffing (eg, 25% [95% CI, 12%-40%] more total puffs for nicotine salts vs freebase). All study e-liquids reduced urges and cravings, with 5% vs 1% nicotine being more effective (mean [SE] QSU-Desire score at 35 minutes, 15.4 [0.5] vs 16.7 [0.5]). In this crossover randomized clinical trial among young adult e-cigarette users, salt-based (vs freebase) nicotine e-liquids increased nicotine intake and yielded more positive subjective effects ratings and intense puffing behaviors, suggesting higher abuse potential. Restricting the level of acidic additives and menthol flavoring may reduce the addictiveness of e-cigarettes. ClinicalTrials.gov Identifier: NCT05458895.

A Randomized Clinical Trial of a Quitline Vaping Cessation Intervention: Baseline Characteristics of Young Adult Exclusive E-Cigarette Users Seeking Treatment.

Despite interest in quitting vaping among young adults (YAs), little is known about characteristics of e-cigarette (EC) users seeking treatment. In this study, YAs aged 18-24 living in the United States interested in vaping cessation treatment were recruited to complete an online survey regarding demographics and EC use. Primary eligibility criteria were EC use on at least 20 days per month (no other tobacco use), and interest in quitting in the next month. We report descriptive statistics for those who did and did not complete a mandatory coaching call (n = 981). In this sample, most EC users reported high nicotine dependence, a history of unsuccessful quit attempts (including 29.4% with previous NRT use), along with stress, anxiety, and depression. There were few meaningful differences in demographics, EC use behaviors, or behavioral health factors between those who engaged with a phone coaching call (fully enrolled in study; n = 508), and those who did not (n = 473). YAs demonstrated interest in vaping cessation support, but there were no clear characteristics for the half who did not complete a coaching call. Vaping cessation program designers should consider tailoring for the self-reported behavioral health concerns present in this population.

Statistical methods for predicting e-cigarette use events based on beat-to-beat interval (BBI) data collected from wearable devices.

The prevalence of e-cigarette use among young adults in the USA is high (14%). Although the majority of users plan to quit vaping, the motivation to make a quit attempt is low and available support during a quit attempt is limited. Using wearable sensors to collect physiological data (eg, heart rate) holds promise for capturing the right timing to deliver intervention messages. This study aims to fill the current knowledge gap by proposing statistical methods to (1) de-noise beat-to-beat interval (BBI) data from smartwatches worn by 12 young adult regular e-cigarette users for 7days; and (2) summarize the de-noised data by event and control segments. We also conducted a comprehensive review of conventional methods for summarizing heart rate variability (HRV) and compared their performance with the proposed method. The results show that the proposed singular spectrum analysis (SSA) can effectively de-noise the highly variable BBI data, as well as quantify the proportion of total variation extracted. Compared to existing HRV methods, the proposed second order polynomial model yields the highest area under the curve (AUC) value of 0.76 and offers better interpretability. The findings also indicate that the average heart rate before vaping is higher and there is an increasing trend in the heart rate before the vaping event. Importantly, the development of increasing heart rate observed in this study implies that there may be time to intervene as this physiological signal emerges. This finding, if replicated in a larger scale study, may inform optimal timings for delivering messages in future intervention.

"It's the Wild West Out There": A Qualitative Study of the Views and Preparedness of Health Professionals in Helping Young Adult E-cigarette Users to Quit.

Young adults (YA) are attempting to quit vaping, with many accessing smoking cessation programs with a lack of reported efficacy, highlighting the need for targeted vaping cessation support. Young people report seeing health professionals (HPs) as potential sources of support in the quitting process. Additionally, the current changing regulatory landscape around vaping in Australia potentially increases the number of those seeking health professional help for cessation. However, limited research exists on HPs' views and preparedness to assist YA with their vaping cessation; thus, this exploratory study aimed to gain insights into their readiness to support YA in quitting vaping. Data were gathered via eight co-design workshops (two groups each of two hours duration and six semi-structured interviews of 1-hour duration), facilitated online with 12 HPs. Data underwent thematic analysis. HPs expressed a need for more information in supporting YA to quit vaping, with them presently relying on informal pathways of support and information for their practice. Participants reported a lack of evidence-based guidelines and a reluctance to prescribe nicotine vapes, expressing conflict with the changing regulatory landscape in Australia. Our findings identify a significant gap in health professional preparedness in supporting vaping cessation. HPs are working within a rapidly evolving regulatory environment and are feeling unprepared to address the widely spread issue of vaping, especially among young people. We demonstrate the critical need for guidelines and training of HPs to enable them to better support young people in quitting vaping. This qualitative study offers unique insights into the views and readiness of Australian HPs to support young people to quit vaping, specifically in the context of recent regulatory reforms. The results highlight the need for evidence-based guidance and training for HPs to inform their vaping cessation support practice.

Salivary lipid changes in young adult tobacco smokers and e-cigarette users: a hidden risk to oral health?

A cross-sectional, age- and gender-matched study was conducted to investigate the effects of different forms of nicotine delivery on salivary lipid profiles among young adult novice smokers compared to non-smokers. To assess the effect of smoking traditional cigarettes, e-cigarettes, and heated tobacco products (HTPs) on the levels of specific sphingolipids (sphingosine, sphinganine, and sphingosine-1-phosphate), various ceramides, and lipid peroxidation products [malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE)] in both unstimulated and stimulated saliva samples collected from healthy young adults who had been smoking for 1-3 years and used only 1 of the 3 nicotine delivering methods. Selection criteria included healthy young adults under 30 years old, with normal BMI and typical diet composition, and with no oral inflammatory lesions, orthodontic/dental appliances, or recent intake of medications or supplements. A total of 75 smokers and 25 non-smokers were enrolled in the study. Smokers were categorized into three groups, each comprising 25 individuals: traditional cigarette smokers, e-cigarette users, and HTPs smokers. Saliva samples were collected and analyzed for sphingolipid concentrations using ultra-high-performance liquid chromatography-tandem mass spectrometry. The concentrations of MDA and 4-HNE were measured using colorimetric and ELISA assays, respectively. The average smoking intensity inthe traditional cigarette group was 10 cigarettes per day. Salivary sphingolipid and ceramides concentrations were significantly lower in smokers compared to non-smokers across all nicotine delivery methods (p < 0.0001). Moreover, traditional cigarette smokers exhibited higher levels of 4-HNE and MDA in both stimulated and unstimulated saliva, compared to non-smokers (p < 0.01). In stimulated saliva, both MDA and 4-HNE in e-cigarette users, and MDA in HTPs users, showed significantly lower concentrations than their comparators in traditional cigarette smokers (p < 0.01). Different nicotine delivery methods impact salivary lipid profile during the initial period of smoking habit. Reduced sphingolipids and elevated lipid peroxidation products suggest a disturbed lipid balance in the oral cavity due to enhanced oxidative stress within the salivary glands of novice smokers.

Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Examining psychometric properties of the Metacognitions about Smoking Questionnaire among young e-cigarette users

ObjectiveMetacognition can be understood as ‘cognition of cognition’ or ‘thinking about thinking’. Metacognition research has primarily focused on cigarette smoking, while e-cigarette use has been relatively unexplored. The study sought to examine the properties of the Metacognitions about Smoking Questionnaire (MSQ), as it was adapted for use among adolescent and young adult e-cigarette users. Further, the study sought to examine the ability of the Metacognitions about Smoking Questionnaire (MSQ) to predict past 30-day e-cigarette use among adolescent and young adult e-cigarette users. MethodsThe study analyzed data collected by the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in Spring 2020. The instrument consisted of 20 items found to have sound psychometric properties when validated among self-defined cigarette smokers in the UK. The instrument was adapted for e-cigarette use by providing a brief description before the items. Participants were asked “Which of the following products you use most often?”, and those who selected “e-cigarettes” were included in the study. Participants were then presented with 20 statements about beliefs people hold about using e-cigarette and were instructed to determine their agreement with the statements on a four-point Likert scale with respect to e-cigarette use. Factors were extracted using Exploratory Factor Analysis (EFA) and factor structure was verified using Confirmatory Factor Analysis (CFA). Further, each of the extracted factors were used to predict past 30-day e-cigarette use frequency in the most frequent group, using conditional effects, holding the most frequent category of categorical covariates, mean of continuous covariates and the other two metacognitive factors as reference levels. Past 30-day e-cigarette use was measured as the number of days of use in the past 30-days. ResultsParticipants who reported e-cigarette use in the past 30-days were included in this analysis (n = 244). Participants were in 10th grade (n = 46), 12th grade (n = 92) and two years beyond high school (n = 106). EFA was conducted and items were assessed with varimax rotation. CFA was conducted with multiple models (one factor, two factor and three factor solutions) and the 3-factor solution showed the best fit. Factors were named as ‘positive metacognitions about cognitive regulation’(PMCR) (e.g. ‘…helps me think more clearly’), ‘positive metacognitions about emotional regulation’(PMER) (e.g. ‘…helps me to relax when I am agitated’), and ‘negative metacognitions’(NM) (e.g. ‘It is hard to control my desire for e-cigarettes’). Cronbach’s alpha showed high internal consistency (0.92, 0.90 and 0.91, respectively). The median score (range) was 7 (5–20), 10 (5–20), and 11 (10–40) on PMCR, PMER, and NM factors. Higher scores denote higher levels of outcome expectancies of that factor. Lowest and highest score on PMCR was associated with 15 and 20.4 days of e-cigarette use in the past 30-days, respectively. Similarly, lowest and highest score on PMER and NM were associated with 13.2 and 21 days, and 14.7 and 24.6 days, respectively. The results indicate that participants who reported highest outcome expectancies for cognitive regulation, emotional regulation, and negative outcomes, used e-cigarettes on average 5, 8 and 10 days more than those who reported lowest outcome expectancies for these factors. ConclusionThe MSQ showed good psychometric soundness for measuring metacognitive factors associated with e-cigarette use. For cigarette smoking, the original questionnaire distinguished negative cognitions of ‘uncontrollability’ and ‘cognitive interference’, which was not seen in e-cigarette users. This indicates a difference in cognitions of cigarette and e-cigarette users. The instrument can help understand the similar role of cognition in e-cigarette use behavior and further assess association with e-cigarette use.

Sex Differences in Oxidative Stress-Mediated Reductions in Microvascular Endothelial Function in Young Adult e-Cigarette Users.

Chronic electronic-cigarette (EC) use is reported to decrease vascular endothelial function. However, the mechanism(s) mediating this reduction remain unclear. In this study, we examined endothelium- and NO-dependent dilation, and the role of oxidative stress in attenuating these responses, in healthy young EC users (n=20, 10 males/10 females) compared with healthy controls (n=20, 10 males/10 females). We hypothesized that EC would have reduced endothelium- and NO-dependent dilation and administration of the superoxide scavenger tempol would increase these responses in EC. We further hypothesized that female EC would have the greatest reductions in endothelium- and NO-dependent dilation. We assessed microvascular endothelium-dependent vasodilator function in vivo by measurement of cutaneous vascular conductance (%CVCmax) responses to a standardized local heating protocol in control and 10 μM tempol-treated sites. After full expression of the local heating response, 15 mM NG-nitro-L-arginine methyl ester (NO synthase inhibition) was perfused. EC had significantly reduced endothelium- (73±15 versus 87±9%CVCmax; P<0.001) and NO-dependent (48±17% versus 62±15%; P=0.011) dilation. Tempol perfusion increased endothelium-dependent (84±12%CVCmax P=0.01) and NO-dependent (63±14% P=0.005) dilation in EC but had no effect in healthy control. Within female sex, EC had lower endothelium-dependent (71±13 versus 89±7%CVCmax; P=0.002) and NO-dependent (50±6 versus 69±11%; P=0.005) dilation compared with healthy control, and tempol augmented endothelium-dependent (83±13%CVCmax; P=0.002) and NO-dependent (62±13%; P=0.015) dilation. There were no group or treatment differences within male sex. Healthy young adult EC users have reduced microvascular endothelium-dependent and NO-dependent dilation, driven by greater reductions in female EC users, and mediated in part by superoxide.

Psychoactive Comfort Products or Snacks: How Chinese Young Adults Perceive the Potentially Addictive Nature of E-Cigarettes.

The potential health value and pitfalls of e-cigarettes are currently under dispute in the scientific community. Exploring young adult e-cigarette users' perceptions would assist in adding a public dimension of understanding to the literature and in scientific public health decision making. Therefore, in this study, we collected and analyzed data from interviews with young adult (n = 14) e-cigarette users and found that many referred to e-cigarettes as "snacks," indicating that they considered that both their frequency of use and addiction were manageable and that they could stop using e-cigarettes at any time. To further understand the behavior of Chinese young adults in relation to their perception of e-cigarettes as a "snack", the study developed a social context framework (crossroads model) and psychological judgment model to explain how youth e-cigarette users' perception of "controlled addiction and ready cessation" arises. These models can be used to assess the effectiveness of e-cigarette policy.

Young adults' beliefs about modern oral nicotine products: Implications for uptake in nonvapers, dual use with e-cigarettes, and use to reduce/quit vaping.

Modern oral nicotine products (ONPs; nontherapeutic nicotine pouches, gums, lozenges, and gummies) may be perceived in ways that could promote uptake in nonvapers, dual use with e-cigarettes, or use to quit vaping. In this cross-sectional digital remote survey of 1,460 respondents aged 21-24 from Southern California, we examined beliefs about ONPs among past-30-day e-cigarette nonusers, users unmotivated to quit vaping, and users motivated to quit vaping. Positive beliefs about ONPs were reported by 31.8% of the overall sample and higher in past-30-day e-cigarette users (with or without quit motivation) than nonusers. Perceiving ONPs to be easy to conceal, convenient, and able to be used where vaping/smoking is not allowed were the most common types of beliefs reported. Among e-cigarette users with quit motivation (n = 142), interest in using ONPs to quit/reduce vaping (44.4%) was higher than interest in using medicinal nicotine gum/lozenges (23.4%), nicotine patch (17.6%), or prescription medications (16.6%). Interest in using ONPs to reduce/quit vaping (vs. no interest) was greater among participants who reported vaping ≥ 20 (vs. < 10) days in the past month, vaping ≥ 10 (vs. < 10) times per day, low/moderate (vs. high) quit vaping self-efficacy, and low/moderate (vs. high) desire to quit vaping. These findings suggest that: (a) appreciable subsets of the young adult population may hold positive beliefs about ONPs that could promote ONP uptake, particularly e-cigarette users and (b) some young adult e-cigarette users may be interested in using ONPs to reduce/quit vaping, particularly frequent vapers with relatively lower self-efficacy and desire to quit vaping. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of Discontinued E-Cigarette Use at One-Year Follow-Up in a Sample of Young Adults.

Currently, the research on factors associated with young adults' discontinuation of e-cigarette use behavior is limited. This study tested the predictors of self-reported e-cigarette abstinence at one-year follow-up among young adult baseline current e-cigarette users. The following variables were tested as predictors: demographics, cigarette smoking, e-cigarette use dependence, e-cigarette use duration, harm perceptions, and preferred aspects of e-cigarette use, including sensations, flavor, and device characteristics. Data were provided at two time-points one year apart by 435 ethnically diverse young adults (M age = 22.3, SD = 3.1; 63% women) who reported current e-cigarette use at baseline. Approximately 42% of those who reported current e-cigarette use at baseline (i.e., 184 out of 435 participants) reported discontinuation of e-cigarette use at one-year follow-up. Results indicated that higher e-cigarette dependence, longer history of e-cigarette use, lower e-cigarette harm perceptions, greater preference for both menthol and sweet flavors, for open-pod-based devices, and for e-cigarette use sensations such as buzz, taste and smell of flavors, and throat hit at baseline were associated with lower likelihood of e-cigarette use discontinuation at one-year follow-up. Characteristics associated with nicotine (e.g., dependence) and flavors (e.g., taste and smell) appear to drive the continuation/discontinuation of e-cigarette use among young adults. Thus, cessation strategies may need to be developed with a focus on dependence and harm perceptions related to nicotine and flavors. Furthermore, better regulating open-pod-based devices and sweet-menthol flavors may help e-cigarette use prevention.

Perceived Sensory Characteristics of Blended and Ambiguous "Concept" Flavors Among Adolescent and Young Adult E-cigarette Users.

Flavors with names describing blended tastes/sensations or with ambiguous terminology ("concept flavors") are available on the e-cigarette market. This study investigates adolescent and young adult use and sensory perceptions of blended and concept flavors. Current e-cigarette users aged 15-24 years (N = 2281) completed an online convenience sample survey (October 20-November 23, 2020) and rated the sensory attributes (fruity, cooling, sweet, and minty) of their current flavor(s) using nine-point scales. T-tests compared mean sensory perception scores within and between flavors. To compare concept flavors to blends, reference categories used the average of blends with relevant descriptors: fruit (Banana Ice, Iced Mango, Melon Ice, Cool Cucumber); cooling (Banana Ice, Iced Mango, Melon Ice, Blue B Ice, Cool Cucumber, Lush Ice, and Menthol Purple); sweet (Vivid Vanilla) and mint (Mint-sation). Most respondents had used at least one product with blended descriptors (74.8%) or concept flavor (57.9%) in the past 30 days. All flavors had high perceived strength for at least two sensory attributes. Mint taste was not perceived to be a strong sensory characteristic for all but two flavors (Mint-sation and Winter) in the study. The most commonly used flavors used blended descriptors (Iced Mango was used by 30.2% of the sample; Banana Ice: 26.2%; Lush Ice: 23.8%; Melon Ice: 22.9%). Some concept flavors did not significantly differ from flavor blend reference categories for strength of: fruit taste (Bahama Mama and Tropic); cooling sensation (Marigold, Island Breeze, Winter); sweet taste (Bahama Mama, Honeymoon, Island Breeze, Island Cream, Meteor Milk, OMG, Royal Dagger and Tropic); and mint taste (Winter). Blended and concept flavors are used by most young e-cigarette users, who describe these products as fruity, sweet, and cooling. A variety of flavored products with high youth appeal are available in the U.S. market. This study of adolescent and young adult e-cigarette users finds evidence of the popularity of e-cigarette flavors combining a cooling sensation with fruity and sweet flavorings. Some products with this flavor profile do not use characterizing descriptors. Findings inform public health interventions intended to reduce e-cigarette use in young people.

Supporting Youth Vaping Cessation With the Crush the Crave Smartphone App: Protocol for a Randomized Controlled Trial.

The use of e-cigarettes, or vaping, has increased exponentially in the past decade, particularly among youth. Emerging evidence indicates growing nicotine dependence among youth, revealing historically higher rates of dependence among current e-cigarette users compared to rates seen in earlier research. Despite the urgent need for youth vaping cessation interventions, there is limited knowledge about the process of vaping cessation, and few evidence-based interventions are available to young people seeking support. A notable literature review on vaping cessation resources for young people recommended technology-based interventions, such as smartphone apps and SMS text messaging services, as a promising area of vaping cessation research and intervention development. The primary aim of our study is to determine the effectiveness of the Crush the Crave app in supporting vaping cessation among youth recruited to the intervention arm via comparison with an assessment-only control group. The primary hypothesis is that participants in the intervention group-those using Crush the Crave-will be more likely to be abstinent at the 6-month follow-up point than participants in the assessment-only control arm. A 2-arm, single-blind, parallel randomized controlled trial will be conducted over 12 months. Study invitations will be sent to 600 youth (age: 16-18 years) and young adult (age: 19-29 years) e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The primary hypothesis is that participants in the intervention group-those using Crush the Crave-will be more likely to be abstinent at the 6-month follow-up point. Study recruitment began on March 4, 2022. Recruitment is anticipated to be completed in December 2022. This protocol describes one of the first-ever randomized controlled trial studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among youth aged 16 to 18 years and young adults aged 19 to 29 years. The findings from our trial will help increase our understanding of the process of vaping cessation among youth and provide evidence on the effectiveness of an app-based intervention in helping young people quit vaping. The trial results will also have implications in the development of current and future approaches to youth vaping cessation. OSF Registries osf.io/hmd87; https://doi.org/10.17605/OSF.IO/HMD87. DERR1-10.2196/42956.

Use of Emerging and Conventional Oral Tobacco Among Adolescent and Young Adult E-Cigarette Users

Background: National surveillance assessing use of novel oral tobacco products (OTPs; nicotine pouches, lozenges, and gums not approved for tobacco cessation) among adolescents and young adults is limited. Objectives: To assess OTP behaviors in a sample of adolescent and young adult e-cigarette users, including use prevalence, dual/poly use with other products, and associated demographics. Methods: A national (United States) cross-sectional survey was conducted from March to April 2021 among 2253 participants (ages 14-20; 65% female) who ever used e-cigarettes ≥3 times. Demographics, lifetime use, and past 30-day use of 10 tobacco and cannabis products, including novel and conventional (chew, moist snuff, or snus) OTPs was assessed. Analysis was descriptive, examining use prevalence (lifetime and past 30-day) of each product, including by demographics and other product use. Results: Nearly 44% reported ever using any OTP, with nicotine pouches being the most commonly ever used (29%) and used in the past month (11%). Novel OTP use was more common among older participants (18–20 years), male participants, and past 30-day users of e-cigarettes, combustible tobacco, and conventional oral tobacco. However, female participants and combustible tobacco non-users were over twice and 4-times as likely, respectively, to use novel OTPs than conventional OTPs. Nearly 73% of past 30-day conventional OTP users were past 30-day novel OTP users. Conclusion: Novel OTP use was prevalent among adolescent and young adult e-cigarette users. Compared to conventional OTPs, novel OTPs likely have greater appeal to females and combustible tobacco non-users. Action to restrict access and reduce interest in OTPs is needed to prevent use among this population.

Differences in intention to use flavored oral nicotine products among young adult e-cigarette users and non-users

New oral nicotine products (ONPs; nicotine pouches, gums, lozenges, and gummies), which are regulated as nonmedicinal tobacco products in the U.S., have flavors and other characteristics that previously attracted young adults to e-cigarettes. Whether young adults’ interest in ONPs differs by e-cigarette use status and quit-vaping motivation is unknown but important for understanding the possible health impact of ONPs. It is particularly important to study if nonmedicinal ONPs attract e-cigarette users interested in quitting vaping, given that nicotine replacement (NRT) therapy uptake in young adults is low. In this study, ONP non-users (ages: 20–24) from California viewed digital images of 5 flavored ONPs (4 nonmedicinal and one NRT gum product) and reported intention to use each ONP (0–100 score). Main and interactive effects of Group (past-6-month e-cigarette non-users [n = 1,1388], e-cigarette users unmotivated to quit vaping [n = 168], and e-cigarette users motivated to quit vaping [n = 99]) and ONP type (nonmedicinal gum, nonmedicinal lozenge, gummy, pouch, and NRT gum) on use intention were tested. For each nonmedicinal ONP, use intention was higher in both e-cigarette user groups than non-users (ds = 0.47–0.59; Ps < 0.001), but did not differ between e-cigarette users with and without quit-vaping motivation (Ps ≥ 0.31). A Group × ONP type interaction was found, whereby higher use intention for e-cigarette users with vs without quit motivation was present for only gum NRT (Cohens d = 0.17; P =.01). Among young adults, e-cigarette users might be more inclined than e-cigarette non-users to try nonmedicinal ONPs regardless of quit-vaping motivation.

Consumption of JUUL vs. Other E-Cigarette Brands among U.S. E-Cigarette Users: Evidence from Wave 5 of the PATH Study.

This study examines the use of JUUL vs. other e-cigarette brands among U.S. youth (12–17 years), young adult (18–24 years), and adult (25 years and above) e-cigarette users. Data were from the Population Assessment of Tobacco and Health (PATH) study Wave 5 survey (2019). The study population was past 30-day e-cigarette users who knew the brand of e-cigarettes they usually/last used (N = 2569). JUUL use was reported by 65.2% of youth, 60.7% of young adult, and 25.6% of adult e-cigarette users in our study sample. The share of JUUL consumed in the past 30 days, measured by the total number of puffs, was 15.4% by youth, 55.5% by young adults, and 29.1% by adults. By contrast, the share of other e-cigarettes consumed was 4.2% by youth, 28.9% by young adults, and 66.9% by adults. Youth JUUL users were more likely to use e-cigarettes within 30 min after waking (aOR = 2.30, 95% CI: 1.12–4.75) than youth users of other brands of e-cigarettes. Additionally, youth e-cigarette users who currently smoked cigarettes were less likely to use JUUL (aOR = 0.55, 95% CI: 0.30–0.99). This study concludes that JUUL consumption was disproportionally higher among youth and young adults in the U.S. in 2019.

Belief and Recall of Nicotine as Therapeutic for COVID-19 May Undermine E-Cigarette Quitting Behavior.

We examine the proposition that misinformation about the therapeutic potential of nicotine to prevent or treat COVID-19 may lead to relapse among attempted e-cigarette quitters. A sample of N = 507 e-cigarette ever-users who reported at least one quit attempt in the past year were surveyed in June of 2021 for recall and belief in several claims about COVID-19 and nicotine. Participants who recalled and believed at least one misinformation claim were significantly more likely to have relapsed than those who did not recall or believe such claims. These differences remained robust to regression analysis adding demographic covariates and accounting for continuous measurement of recall and belief. Misinformation about e-cigarette use is reaching young adult e-cigarette users who are trying to quit. The implications of these findings merit further research to characterize potential barriers to successful e-cigarette cessation.

Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas

Given the 2020 federal restrictions on flavored cartridge-based e-cigarettes and increasing state/local flavored e-cigarette sales restrictions, this mixed-methods study examined US young adult e-cigarette users’ responses to flavored e-cigarette sales restrictions (e.g., changes in use, products used, access). We descriptively analyzed Fall 2020 survey data from 726 past 6-month e-cigarette users (Mage = 24.15, 51.1% female, 4.4% Black, 10.2% Asian, 12.1% Hispanic, 35.5% sexual minority), and qualitatively analyzed Spring 2021 semi-structured interview data among 40 participants (Mage = 26.30, 35.0% female, 5.0% Black, 22.5% Asian, 12.5% Hispanic, 45.0% sexual minority). Across all participants (i.e., survey and interview participants), ≥80% most commonly used non-tobacco flavors; ≥40% used tank-based devices. Survey participants most commonly reported that the federal restrictions did not impact their use: 35.8% used available flavors (i.e., tobacco, menthol), 30.4% continued to use tank-based e-cigarettes, and 10.1% switched to tank-based e-cigarettes. Only 8.4% reduced their e-cigarette use. Among interview participants, some indicated no impact on their e-cigarette use because they stocked up or obtained flavors from alternative sources (e.g., online). Some filled their own pods with e-liquids, switched to menthol/tobacco flavors, switched e-cigarette devices or brands, and/or reduced use. Regarding the anticipated impact of comprehensive flavor restrictions, some participants reported that they would: 1) quit vaping; 2) switch to cigarettes; or 3) not change their use (e.g., stock up on flavors). The potential unintended reactions to flavored e-cigarette sales restrictions (e.g., continued use of flavored cartridge-based e-cigarettes) underscore the need for ongoing surveillance of retail and consumer behavior to inform policy and compliance/enforcement efforts.