Young E-cigarette Users Research Articles

12582 Electronic-cigarette Exposure Induces Hyperglycemia With A Fibrotic Phenotype In Skeletal Muscle In Mice Subjected To A High-fat Diet

Abstract Disclosure: J. Rivera: None. J. Chavez: None. J. Espinoza-Derout: None. K.M. Hasan: None. X.M. Shao: None. A.P. Sinha-Hikim: None. T.C. Friedman: None. Obesity and electronic cigarette (e-cigarette) use are highly prevalent among youth in the USA. Indeed, young e-cigarette users report less physical activity, leading to a decline in quality of life. Recent studies show e-cigarettes reduce skeletal muscle (SkM) performance in mice; however, the underlying metabolic and SkM cellular effects are unclear. E-cigarettes plus a high-fat diet (HFD) increase mice lipolysis and plasma-free fatty acids. These harmful changes in the liver and heart are prevented by the lipolysis inhibitor Acipimox (Acip). As SkM plays a crucial role in metabolic and chronic disease prevention, understanding the impact of e-cigarettes and HFD on SkM is essential.We exposed C57BL6 mice to e-cigarette inhalation in a free-moving system to deliver 2.4% nicotine in a similar way to humans. Mice were fed with an HFD and divided into 3 groups: Saline (control), e-cigarette (bluCig), and e-cigarette plus Acip (rescue group) for 12 weeks. SkM uptakes 70-80% of the postprandial glucose, so we performed a glucose tolerance test. We found higher glycemia in the e-cigarette compared to the Saline group, while the e-cigarette plus Acip group showed improved glycemia. Histological analysis of SkM with Hematoxylin and eosin (HE) staining revealed large extracellular fibrotic structures in the group with e-cigarettes, suggesting fibrosis. Sirius Red (SR) stain identified collagen deposition. The SR quantification showed an increase in the collagen in the e-cigarette to the saline-exposed group without recovery in the e-cigarette plus Acip group. Fibrosis restricts the SkM hypertrophy. So we analyzed the insulin-like growth factor-1 (IGF-1) (a key anabolic factor) by RT-qPCR. The mRNA levels of IGF-1 were reduced in the SkM of e-cigarettes compared to the Saline group, without recovery of the Acip group. In SkM hypertrophy, Satellite cells (SCs) are stimulated by IGF-1 and SkM fibrosis can affect SCs by restricting them. So we analyzed by western blot the SCs through the transcriptional factor PAX7 (SC marker). We found PAX7 levels were lower in the e-cigarette compared with the Saline group without recovery in the Acip group. These findings suggest the detrimental effects of e-cigarettes on glycemia and SkM health in mice, with implications for long-term health outcomes, particularly among obese individuals and e-cigarette users. Further research is necessary for understanding these adverse effects and promoting youth health. GRANT SUPPORT: U54MD007598, SC2GM135127, U54MD007598-14S2, PR190942, DA050723, and R25DA050723 grants. Presentation: 6/3/2024

Online social platform engagement by young treatment seekers in a digital vaping cessation intervention: Effects on confidence in the ability to quit vaping and vaping abstinence

BackgroundThe evidence-based vaping cessation program, This is Quitting (TIQ), has been found to be effective in promoting abstinence among young people who use e-cigarettes. PurposeTo estimate acceptability and engagement with Discord among treatment seeking youth and young adults and assess the benefit of adding an online social platform via Discord to TIQ. MethodsBetween February and March 2023, 527 TIQ participants (aged 13–24 years) were invited to join Discord with other TIQ users (TIQ Discord). Participants completed two online surveys, at baseline and 1-month post study enrollment. Descriptive statistics were used to describe acceptability and engagement with TIQ Discord. Chi-square, Fisher's exact, and t-tests were used to compare changes in confidence in ability to quit and vaping abstinence across those who joined and engaged with TIQ Discord, compared to those receiving TIQ only. ResultsAmong the n = 319 who were invited to TIQ Discord and provided follow-up data, 57.4 % joined. Among those who joined (n = 183), 61.7 % engaged with TIQ Discord by contributing at least one message or reaction. The mean number of contributed messages was 4.0 (median = 1, range = 1 to 51) and reactions was 0.31 (median = 0, range = 0 to 14). Engaging with TIQ Discord was positively associated with increased confidence in quitting at follow-up (p-value = 0.02), but vaping abstinence at follow-up did not differ (p-value = 0.87). DiscussionOver half of participants who were invited to TIQ Discord joined – indicating high acceptability and an uptake rate that is higher than what is typically observed for online cessation communities. Engagement was positively associated with proximal outcomes, but self-selection prevents causal attribution. Pilot study results suggest acceptability of Discord for providing digital cessation support to young people in combination with a text-message cessation intervention.

Treatment-seeking young people enrolled in a United States vaping cessation intervention trial report high frequency of use and nicotine dependence

ObjectiveThis study examines characteristics of participants enrolled in a vaping cessation intervention trial and study generalizability of the treatment-seeking sample to the broader population of young people interested in quitting vaping to evaluate dissemination of an evidence-based treatment program. MethodsData was obtained from 697 treatment-seeking participants (aged 13–24 years) from a vaping cessation intervention trial conducted between February and March 2023 with This is Quitting and 665 participants who expressed intent to quit vaping in the Truth Longitudinal Cohort, a nationally representative longitudinal study of United States youth and young adults (aged 15–24 years), collected October 2022 to February 2023. Comparisons were made using two-sample Pearson Chi-square tests and t-tests. ResultsTreatment-seeking young people were younger, less racially diverse, more diverse in sexual orientation, and reported higher psychological distress, frequency of e-cigarette use, and nicotine dependence, relative to the nationally representative sample of young people expressing intentions to quit vaping. ConclusionsParticipants enrolled in treatment reported higher levels of dependence and use frequency than the broader population, suggesting that many young e-cigarette users with lower dependence who want to quit might not be reached by current treatment dissemination efforts. The implication of these findings is that communications for vaping cessation programs may need to be adjusted to have broader appeal among young people.

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 e-cigarette users

Tobacco and nicotine use cause vascular endothelial dysfunction, increasing lifetime cardiovascular disease risk. Chronic e-cigarette use is reported to decrease endothelial function, however the mechanism(s) mediating this reduction remain unclear. Using the cutaneous circulation as a model, we examined endothelium- and nitric oxide (NO)-dependent dilation, and the role of oxidative stress in attenuating these responses, in otherwise healthy, young chronic (≥6 months) e-cigarette users (EC) compared to healthy controls (HC). We hypothesized that: EC would have reduced endothelium- and NO-dependent dilation, and local tempol (superoxide scavenger) administration would increase these responses in EC. We further examined the effect of sex within HC and EC and hypothesized that female EC would have the greatest reduction in endothelium- and NO-dependent dilation. 20 HC (21±2 yrs; 10M/10F) and 18 EC (21±2 yrs; 10M/8F) underwent a standard local heating protocol (42°C; 0.1°C·s-1). Two intradermal microdialysis fibers were placed in the ventral forearm skin for local delivery of lactated Ringer’s (control), or 10μM tempol. After full expression of the local heating response, 15mM NG-nitro-L-arginine methyl ester (L-NAME; NO synthase-inhibition) was perfused. Red cell flux was measured continuously by laser-Doppler flowmetry, and cutaneous vascular conductance (CVC=flux/MAP) was standardized to maximum (%CVCmax; 28mM SNP + 43°C). Between groups, endothelium- (EC: 73 ± 15 vs HC: 87 ± 9 %CVCmax; p<0.001) and NO-dependent (EC: 48.1± 17.0% vs. HC: 61.8 ± 14.7%; p=0.011) dilation were attenuated in EC compared to HC. Local tempol perfusion increased endothelium- (83.8 ±12.1% p=0.007) and NO-dependent (61.4 ± 14.2% p=0.011) dilation in EC but had no effect in HC (all p>0.05). Within sex, female EC had lower endothelium- (EC: 69.9±3.4 vs HC: 89.1±3.5 %CVCmax; p<0.001) and NO-dependent (EC: 46.9±5.5 vs HC: 69.4±5.0%; p=0.005) dilation compared to female HC, but there were no differences between these responses in HC and EC males (both p>0.05). Tempol perfusion augmented endothelium- (83.4±4.4 %CVCmax; p=0.31) and NO-dependent (60.2±5.1%; p=0.04[AS1] ) dilation in EC females but had no effect in EC males (both p>0.05). These data suggest that otherwise healthy young adult e-cigarette users have reduced microvascular endothelium- and NO-dependent dilation. Within e-cigarette users, these results are driven by greater reductions in females, and superoxide contributes to these impairments. Supported by NIEHS/NIH P30 ES005605 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Vaping and Health Service Use: A Canadian Health Survey and Health Administrative Data Study.

Rationale: Emerging research suggests that e-cigarette (EC) use may have detrimental health effects, increasing the burden on healthcare systems. Objectives: To determine whether young EC users had increased asthma, asthma attacks, and health services use (HSU). Methods: This cohort study used the linked Canadian Community Health Survey (cycles 2015-16 and 2017-18) and health administrative data (January 2015-March 2018). A propensity score method matched self-reported EC users to up to five control subjects. Matched multivariable logistic and negative binomial regressions were used to calculate odds ratios, rate ratios (RRs), and 95% confidence intervals (CIs) with EC use as the exposure and asthma, asthma attacks, and all-cause HSU as the outcomes. Results: Analyses included 2,700 matched Canadian Community Health Survey participants (15-30 yr), 505 (2.4% of 20,725 participants) EC users matched to 2,195 nonusers. After adjusting for confounders, EC users with asthma had over twofold higher odds of having an asthma attack in the last 12 months (odds ratio, 2.30; 95% CI, 1.29-4.12). Dual EC and conventional tobacco users had a twofold increased all-cause HSU rate compared with nonusers who never smoked tobacco (RR, 2.13; 95% CI, 1.53-2.98). This rate was greater than that for EC users who never smoked tobacco (RR, 1.73; 95% CI, 1.00-3.00) and non-EC users who regularly smoke tobacco (RR, 1.72; 95% CI, 1.29-2.29). Compared with male nonusers, female EC users had the highest increased all-cause HSU (RR, 1.94; 95% CI, 1.39-2.69) over male EC users and female nonusers (RR, 1.13; 95% CI, 0.86-1.48; RR, 1.41; 95% CI, 1.16-1.71, respectively). Conclusions: Current EC use is associated with significantly increased odds of having an asthma attack. Furthermore, concurrent EC use and conventional cigarette smoking are associated with a higher rate of all-cause HSU. The odds of asthma attack and all-cause HSU were highest among women. Thus, EC use may be an epidemiological biomarker for youth and young adults with increased health morbidity.

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.

Have E-cigarette Risk Perception and Cessation Intent of Young Adult Users Changed During the Pandemic?

Objectives: Emerging evidence indicates that young adults who use e-cigarettes can withhold greater exposure to COVID-19 risk. We examine how young e-cigarette users perceive COVID-19 related threat of e-cigarette use and benefit of cessation as compared to traditional ones, applying the health belief model. We investigate changes of such perceptions during the pandemic and their associations with past attempt and future intent to quit e-cigarette use. Methods: We collected responses from US young adults (aged 18-25) who have used e-cigarettes in the past month by conducting 2 waves of online surveys in 2020 (wave 1, N=165) and 2021 (wave 2, N=347). Results: Young e-cigarette users in wave 2 reported greater estimates of COVID-19 and traditional threat as well as COVID-19 and traditional benefit of quitting than wave 1. However, we also found significant increases of e-cig dependence, perceived barriers of quitting, and the percentage of young e-cigarette users (33%) who had never attempted to quit in the past month. Importantly, a COVID-19 benefit of cessation and efficacy of quitting were significantly associated with cessation intent. Conclusions: Ongoing efforts are required to track post-pandemic e-cigarette risk perceptions and behaviors, as well as to identify strategies to mitigate increased dependence and usage of e-cigarettes.

Electronic Cigarette Cessation among Adolescents and Young Adults

Background E-cigarette use is common among adolescents and young adults, yet little is known about e-cigarette cessation among this group. The current study assessed e-cigarette cessation attempts, interest in e-cigarette cessation, and methods of e-cigarette cessation most favored by young e-cigarette users. Methods A cross-sectional survey was administered via Facebook and Instagram between February and April 2019 to enroll current, regular e-cigarette using adolescents and young adults who reported non-regular use of other tobacco products. Participants included 212 (51.4% female) adolescents and young adults (14 to 21 years of age) who reported six or more days of e-cigarette use and less than four days of other tobacco product use in the last 30 days. Results More than half (n = 110; 51.9%) of the participants reported at least one past serious e-cigarette quit attempt. Among those, the average number of past quit attempts was 2.9 (SD = 3.9). Of the 157 (74.1%) participants who indicated they were interested in quitting e-cigarettes, 78 (49.7%) endorsed health risks as their primary reason for wanting to quit e-cigarettes. The most frequently endorsed intervention methods to aid in e-cigarette cessation were those delivered via digital methods, such as smartphone apps. Conclusion The current study provides preliminary data to support continued development of e-cigarette cessation treatments for adolescents and young adults. Future research should evaluate the potential use of digital methods to aid in e-cigarette cessation.

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

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

Modeling the effect of stress on vaping behavior among young adults: A randomized cross-over pilot study

BackgroundLaboratory models have been useful in identifying the motivational processes underlying tobacco use. This pilot study aimed at (1)validating a human laboratory model initially developed for smokers to e-cigarette users; (2)applying this model to examine the effects of stress on the reinforcing value of nicotine among young adults. MethodsUsing a randomized cross-over design, young e-cigarette users (n = 30) who were nicotine deprived were exposed to a stress or a non-stress task, and then engaged in a laboratory task assessing vaping’s reward value on two separate days. During the first part of the task, participants had the option of initiating an e-cigarette self-administration session or delaying initiation for up to 50 min in exchange for money. During the second part of the task, participants chose between vaping or receiving money. The length of the delay and the number of e-cigarette uses consumed were the primary outcomes. Craving and puff topography were secondary outcomes. ResultsThere was no difference in the length of time that participants were able to refrain from vaping in the stress and control task (p = .90). Participants purchased and consumed more puffs after being exposed to the stress task compared to the control task (p<.001), puff topography and craving were unaffected. ConclusionsExposure to a stressor did not undermine the ability to resist vaping among deprived e-cigarette users (first part), but it influenced the number of uses purchased once users decided to vape (second part). This study evidences that these two parts of the task for assessing reward value are differentially sensitive to the stress manipulation.

Indicators of dependence and efforts to quit vaping and smoking among youth in Canada, England and the USA

ObjectiveThe current study examined indicators of dependence among youth cigarette smokers and e-cigarette users in Canada, England and the USA, including changes between 2017 and 2019.MethodsData are from repeated cross-sectional...

Adolescents and Young Adults Have Difficulty Understanding Nicotine Concentration Labels on Vaping Products Presented as mg/mL and Percent Nicotine.

E-cigarette e-liquid nicotine concentrations typically are labeled as mg/mL or percent nicotine. We examined whether these metrics accurately convey nicotine strength to young e-cigarette users and if youth can compare concentrations presented in mg/mL and percent nicotine. Eight hundred and twenty-one adolescent and young adult e-cigarette users participated in the survey. Participants rated nicotine concentration strengths presented as mg/mL (0-60 mg/mL) and percent nicotine (0%-6%) from "no nicotine" to "very high nicotine." Participants also viewed pairs of nicotine concentrations (eg, 18 mg/mL vs. 5%) and indicated which concentration was stronger or if the concentrations were equivalent. On average, participants correctly identified 5.92 (2.68) of 18 nicotine strengths, correctly identifying strengths labeled as mg/mL (3.47 [2.03]) more often than percent nicotine (2.45 [1.38], p < .001). Excluding nicotine-free, participants rated concentrations presented as mg/mL as stronger, more addictive, and more harmful than equivalent concentrations presented as percent nicotine. Participants seldom correctly identified that one concentration was stronger or that both were equivalent (7.58 [5.88] of 19 pairings), although they more often correctly identified the stronger concentration when it was presented in mg/mL (4.02 [SD = 3.01]) than in percent nicotine (2.53 [2.73], p < .001). The most consistent predictor of correct answers on these tasks was familiarity with using both products labeled as mg/mL and labeled as percent nicotine. Young e-cigarette users had difficulty understanding nicotine concentrations labeled using the most common metrics, raising concerns about inadvertent exposure to high nicotine levels and suggesting that a more intuitive labeling approach is needed. This study extends prior work showing that young e-cigarette users often are uncertain whether the e-liquids they use contain nicotine by demonstrating that adolescents and young adults have difficulty understanding nicotine concentrations labeled using the two most common metrics (mg/mL and percent nicotine). Errors generally underestimated nicotine strength, and users were not able to accurately compare nicotine concentrations presented as mg/mL and percent nicotine. Difficulty understanding labeling metrics persisted even after accounting for user characteristics like age and vaping experience, suggesting that a novel, easy to understand labeling system is needed to convey information about nicotine strength accurately.

Quitting e-cigarettes: Quit attempts and quit intentions among youth and young adults.

While youth and young adult e-cigarette use has risen in the U.S., few studies have explored e-cigarette cessation behavior. This study estimates quit attempts and intentions among young people (aged 15-36) since the rise of high-nicotine products, and examines factors associated with e-cigarette quit attempts and intentions. Current e-cigarette users (past 30-day use, not already quit) were drawn from a national probability-based cohort sample. Data were collected from September to December 2019 (n=1158). Weighted proportions of past-year quit attempts, intentions to quit in next 30days, and general intentions to quit (at some point) were calculated. Models estimated cessation outcomes with respect to harm perceptions, friend use, dependence, use frequency, combustible use and demographic factors. Among current e-cigarette users, 54.2% reported general intentions to quit, 15.3% reported intention to quit within 30days, and 33.3% reported a past-year quit attempt. Past-year quit attempts were associated with higher levels of harm perceptions (adjusted odds ratio (aOR)=2.08, 95% confidence interval (CI): 1.49-2.92), dependence (aOR=1.92, 95% CI: 1.44-2.56) and daily use (28+days) compared to infrequent use (1-5days) (aOR=0.23, 95% CI: 0.12-0.43). General intentions to quit were positively associated with harm perceptions (aOR=1.77, 95% CI: 1.23-2.56) and dependence (aOR=1.89, 95% CI: 1.41-2.52), and negatively associated with daily use compared to infrequent use (aOR=0.35, 95% CI: 0.19-0.65). Findings indicate that over half of young e-cigarette users want to quit, highlighting a critical need for policies and resources to promote and sustain e-cigarette cessation among young people.

“It’s really addictive and I’m trapped:” A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people

BackgroundDebate continues over how e-cigarettes have impacted the health of young people, and what regulatory policies should be enacted. The debate has appropriately been informed by quantitative studies, often focused on initiation, prevalence, and product transition among the general population and demographic segments. Factors driving cessation and subjective experiences that motivate young users to quit have been largely absent from the debate. This qualitative study highlights the range of motivating experiences among a population of treatment-seeking young e-cigarette users. MethodsThree researchers coded reasons for quitting provided by a sample of n = 1000 youth (13–17) and n = 1000 young adults (18–24) enrolled in a text message cessation program. Data spanned January 18 – February 22, 2019. Codes were adapted from previous literature. ResultsThe most common reasons were health (50.9%; “I want my lungs back”), financial cost (21.7%; “I don't have enough money to feed my addiction”), freedom from addiction (16.0%; “i hate juuling. it's taking over my life”), and social influence (10.1%; “it's affecting my friendships”). Selected quotes highlight a broad range of additional ways in which e-cigarette use negatively impacted young people, including decreased academic performance and mental health. ConclusionsYoung people trying to quit e-cigarettes are motivated by a diversity of reasons including health, financial, social, and academic. The range of impacts should be considered in discussions of policies intended to protect young people, and incorporated into cessation programs designed to serve them.

The Course of E-Cigarette Use in Adolescence: A Cohort Study over 18 Months

Description of adolescent e-cigarette use over time. In 2017 and 2019, 261 adolescents from North Rhine-Westphalia who had used e-cigarettes at least once a month (mean age: 14.9 years; 33.5 % female) took part in a questionnaire study. In 2017, 84 adolescents (32.2 %) reported exclusive e-cigarette use (single users), 177 adolescents were classified as dual users (67.8 %) because they consumed a tobacco product (conventional cigarette and/or hookah) in addition to e-cigarettes. During the observation period of 18 months, 83 adolescents (31.8 %) quit nicotine products altogether. Dual users quit nicotine less often than single users (N = 39 or 22.0 % vs. N = 44 or 52.4 %, p < 0.001). Seven single users (8.3 %) did not change their behavior, 11 began to use tobacco exclusively (13.1 %), another 22 (26.2 %) started dual use. Seventy-eight dual users (44.1 %) did not change their behavior, 57 (32.1 %) switched to tobacco use only, 3 dual users (1.7 %) stopped tobacco use, but continued to use e-cigarettes. Taken together, at the end of the study, 10 (5.6 %) of the remaining 178 adolescents consumed only e-cigarettes, while 168 (94.4 %) smoked tobacco or were dual-users. More than two thirds of all young e-cigarette users and more than three quarters of dual users also used nicotine products 18 months later. The remaining consumers showed a less frequent stay or switch to single use, instead a more frequent use of tobacco or dual use.

Pilot study to inform young adults about the risks of electronic cigarettes through text messaging

IntroductionYoung adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings. MethodsA two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure. ResultsParticipants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02). ConclusionsThis was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.

Querying About the Use of Specific E-Cigarette Devices May Enhance Accurate Measurement of E-Cigarette Prevalence Rates Among High School Students.

Prevalence estimates of electronic cigarette (e-cigarette) use may underestimate actual use in youth. Confusion resulting from the fact that a multitude of devices (eg, vape pens, JUULs) fall under the umbrella term "e-cigarettes," the use of different names to refer to e-cigarettes (eg, vapes, electronic vaping devices), and the use of different terminology to refer to e-cigarette use (eg, "vaping," "JUULing"), may lead some young e-cigarette users to incorrectly indicate nonuse. Therefore, we compared rates of endorsing lifetime e-cigarette use when adolescents were asked about lifetime e-cigarette use in two different ways. In May to June 2018, a total of 1960 students from two high schools in Connecticut completed a computerized, school-based survey. Participants first reported on lifetime "e-cigarette" use and, subsequently, on lifetime use of five different e-cigarette devices: disposables, cig-a-likes, or E-hookahs; vape pens or Egos; JUULs; pod systems other than JUULs such as PHIX or Suorin; and advanced personal vaporizers or mods. In total, 35.8% of students endorsed lifetime "e-cigarette" use, whereas 51.3% endorsed lifetime use of at least one e-cigarette device. The kappa statistic indicated only 66.6% agreement between the methods of assessing e-cigarette use. Overall, 31.5% of adolescents who endorsed lifetime device use did not endorse lifetime "e-cigarette" use, although rates of discordant responding varied across subgroups of interest (eg, sex, race). Assessing adolescents' use of specific e-cigarette devices likely yields more accurate results than assessing the use of "e-cigarettes." If these findings are replicated in a nationally representative sample, regulatory efforts requiring all e-cigarette devices to be clearly labeled as "e-cigarettes" may help to reduce confusion. Different prevalence estimates of lifetime e-cigarette use were obtained depending on the way that prevalence was assessed. Specifically, fewer adolescents (35.8%) endorsed lifetime e-cigarette use when they were asked "Have you ever tried an e-cigarette, even one or two puffs?" than when they were queried about lifetime use of five different e-cigarette devices (51.3%). Among those who endorsed lifetime use of at least one specific e-cigarette device, 31.5% did not endorse lifetime "e-cigarette" use. These findings suggest that when assessing adolescents' lifetime e-cigarette use, using of terms referring to specific devices likely produces more accurate prevalence estimates than using the term "e-cigarettes."

Exposure to Advertisements and Susceptibility to Electronic Cigarette Use Among Youth

PurposeDespite the rapid increase in e-cigarette use among youth, little is known about the social and behavioral factors that have contributed to this rise. We investigated whether young e-cigarette users are susceptible to e-cigarette advertisements. MethodsEstimates of e-cigarette use and exposure to e-cigarette advertisements from the 2014 National Young Tobacco Survey were investigated. Factors associated with the prevalence and levels of e-cigarette use were analyzed using multinomial logistic regression. ResultsOf all respondents (n = 21,491), 19.8% had tried e-cigarettes and 9.4% were current e-cigarette users. Exposure to e-cigarette ads was prevalent among youth, with 38.6%/29.6%/53.2%/35.4% having medium to high exposure to e-cigarette ads from the Internet/newspapers/stores/TV, respectively. Current use of e-cigarettes among youth was associated with frequent exposure (high vs. low) to e-cigarette advertising from the Internet (odd ratio [OR] = 3.1, p < .0001), newspapers/magazines (OR = 2.5, p < .0001), stores (OR = 2.8, p < .0001), and TV/movies (OR = 2.1, p < .0001). In the multivariate analysis that joint analyzed four advertisement channels and covariates, greater exposure to e-cigarette ads on the Internet (adjusted OR = 1.9, p < .0001) and in retail stores (adjusted OR = 1.9, p < .0001) remained to be significantly associated with increased odds of using e-cigarettes. Vaping by other household members significantly increased the risk of adolescent e-cigarette use (OR = 8.7, p < .0001). ConclusionsExposure to e-cigarette ads significantly increased susceptibility to e-cigarette use among adolescents. E-cigarette advertising regulations and educational campaigns are critically needed.

E-Cigarette Television Advertising to Youth

Sales of e-cigarettes in the U.S. have doubled every year since they were introduced. As of 2012, an estimated 1.8 million middle school and high school students had ever used them. Nearly 10% of young e-cigarette users have …