ENDS Device Type and Initiation of Combustible Tobacco Products Among Adolescents

Abstract Introduction The aim of this study was to determine whether Electronic Nicotine Delivery Systems (ENDS) device type (disposable devices, replaceable cartridges, and refillables) at initial or first ENDS use predicts subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) among adolescents and/or differentiates between those who initiate use of both ENDS and combustible tobacco products at the same time. Methods The study examined data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal population-based cohort of students in major metropolitan areas of Texas (n = 3907; N = 461 069). Data were collected every 6 months, from 2014 to 2018; 33.9% (n = 1324; N = 151 784) of the sample initiated ENDS use across this period. Unadjusted and adjusted logistic regression models were used to assess the odds of initiating combustible tobacco products at a subsequent or similar wave as ENDS initiation, given initial ENDS device type. Results After adjusting for sociodemographic factors, the odds of initiating combustible tobacco use subsequent to ENDS initiation were significantly lower among those who reported using Cartridges as their initial device type compared to those who reported Refillables as their initial device type (adjusted odds ratio = 0.42 [0.18–0.98], p = .05). In addition, after controlling for sociodemographic variables, the odds of initiating combustible tobacco use in the same wave as ENDS initiation were significantly higher among those who reported using Cartridges as their initial device type, compared with those who reported Refillables as their initial device type (adjusted odds ratio = 2.31 [1.05–5.10], p = .04). No significant differences were found in adjusted models when Disposables were compared to Refillables and Cartridges to Disposables. Conclusion ENDS device type differentiates between adolescents who start using combustible tobacco products at the same time as initial ENDS use, or subsequently. Implications Previous research has shown ENDS use predicts subsequent combustible use among adolescents, but there is lack of research on the role of specific ENDS device types and the timing of initiation. Findings from this longitudinal study show that initiation of combustible tobacco product use varies by initial ENDS device type among adolescents. These findings can become a focal point for developing interventions for adolescents and could have regulatory implications for ENDS products.

Download Full-text

Blunt and Non-Blunt Cannabis Use and Risk of Subsequent Combustible Tobacco Product Use Among Adolescents

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz225 ◽

2019 ◽

Vol 22 (8) ◽

pp. 1409-1413 ◽

Cited By ~ 1

Author(s):

Margaret E Mayer ◽

Grace Kong ◽

Jessica L Barrington-Trimis ◽

Rob McConnell ◽

Adam M Leventhal ◽

...

Keyword(s):

Odds Ratio ◽

Regression Models ◽

Tobacco Product ◽

Cannabis Use ◽

Tobacco Prevention ◽

Tobacco Products ◽

Total N ◽

Logistic Regression Models ◽

Product Use

Abstract Introduction Cannabis—including blunts (cannabis rolled in tobacco-containing cigar casing) —is commonly the first substance used among adolescents and may increase the likelihood of subsequent initiation of combustible tobacco products. Aims and Methods Data were pooled from two prospective studies of adolescents in California and Connecticut (total N = 4594). Logistic regression models assessed the association of baseline ever blunt use and ever non-blunt cannabis use (vs. never cannabis use) with subsequent initiation of any combustible tobacco-only product (ie, cigarettes, cigars, or cigarillos) by 1-year follow-up after adjustment for demographic characteristics and other tobacco product use at baseline. We also assessed whether estimates differed by prior e-cigarette or hookah use at baseline. Results Among never combustible tobacco-only product users (N = 2973), 221 (7.4%) had ever used a blunt and 114 (3.8%) had ever used only non-blunt cannabis at baseline. Blunt use (adjusted odds ratio [AOR] = 1.98, 95% confidence interval [CI]: 1.30 to 3.01) and non-blunt cannabis use (AOR = 2.38, 95% CI: 1.41 to 4.00) were independently associated with greater odds of combustible tobacco-only product initiation by follow-up. Among those who had not tried e-cigarettes or who had not tried hookah, blunt use and non-blunt cannabis use were associated with significantly increased odds of combustible tobacco product initiation; among those who had tried e-cigarettes or hookah, the association was not significant. Conclusions We found blunt and non-blunt cannabis use to be associated with subsequent combustible tobacco-only product initiation, particularly among adolescents who had not also tried other products containing nicotine. Implications Adolescent-focused tobacco prevention efforts should consider incorporating cannabis products, including blunts. More research is needed to understand how blunt use and cannabis use more broadly are associated with initiation of tobacco products.

Download Full-text

Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01368-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sara C. Auld ◽

Hardy Kornfeld ◽

Pholo Maenetje ◽

Mandla Mlotshwa ◽

William Chase ◽

...

Keyword(s):

Lung Function ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Logistic Regression Models ◽

Pulmonary Impairment ◽

Mixed Pattern

Abstract Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment. Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment. Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78). Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.

Download Full-text

Sex Differences in the Association between Internet Usage and Overweight/Obesity: Evidence from a Nationally Representative Survey in Nepal

Sexes ◽

10.3390/sexes2010011 ◽

2021 ◽

Vol 2 (1) ◽

pp. 132-143

Author(s):

Juwel Rana ◽

Md. Momin Islam ◽

John Oldroyd ◽

Nandeeta Samad ◽

Rakibul Islam

Keyword(s):

Odds Ratio ◽

Regression Models ◽

Internet Use ◽

Adjusted Odds Ratio ◽

Internet Usage ◽

The Internet ◽

Logistic Regression Models ◽

Biological Sex ◽

Obesity Interventions ◽

Nationally Representative

Objective: To examine the associations between internet use and overweight/obesity in people aged 15–49 years in Nepal and the extent to which these associations differ by biological sex. Materials and methods: The study analyzed the nationally representative Nepal Demographic and Health Survey (NDHS) 2016 data. Multivariable ordinal logistic regression models were fitted to estimate the total effects of internet use (IU) in the last 12 months and frequency of internet use (FIU) in the last month on overweight/obesity adjusted for potential confounders. Results: Of the 10,380 participants, the prevalence of overweight/obesity by IU was 38% (95% confidence interval (CI): 35.9%, 40.1%) for males and 44.1% (95% CI: 41.6%, 46.6%) for female. The likelihood of overweight/obesity was significantly higher (adjusted odds ratio (aOR): 1.55; 95% CI: 1.40, 1.73; p < 0.001) among those participants who used the internet compared to the participants who did not use the internet in the last 12 months. Similar associations were observed when using the augmented measure of exposure-FIU in the last month. We observed the modification effect of sex in the associations of IU (p-difference < 0.001) and FIU (p-difference < 0.002) with overweight/obesity in Nepal. Conclusions: Our findings suggest that future overweight/obesity interventions in Nepal discourage unnecessary internet use, particularly among males.

Download Full-text

Support for cigarette filter waste policies among US adults

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056451 ◽

2021 ◽

pp. tobaccocontrol-2020-056451

Author(s):

Minal Patel ◽

Alison F Cuccia ◽

Shanell Folger ◽

Adam F Benson ◽

Donna Vallone ◽

...

Keyword(s):

Smoking Status ◽

Population Based ◽

Tobacco Product ◽

Cross Sectional ◽

Cigarette Filter ◽

Logistic Regression Models ◽

Knowledge And Beliefs ◽

Cigarette Butts ◽

Using Data ◽

The Impact

IntroductionLittle is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.MethodsA cross-sectional, population-based sample of US adults aged 18–64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.ResultsRegardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).ConclusionsComprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.

Download Full-text

Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000518601 ◽

2021 ◽

pp. 1-7

Author(s):

Antoine Gbessemehlan ◽

Gilles Kehoua ◽

Catherine Helmer ◽

Cécile Delcourt ◽

Achille Tchalla ◽

...

Keyword(s):

Older People ◽

Cognitive Performance ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Central Africa ◽

Population Based ◽

Vision Impairment ◽

Sub Saharan Africa ◽

Population Based Study ◽

The Impact

Introduction: Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. Methods: It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. Results: Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). Conclusion: In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

Download Full-text

Racial Disparities in Invasive Management for Patients With Acute Myocardial Infarction With Chronic Kidney Disease

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.121.011171 ◽

2021 ◽

Author(s):

Jennifer A. Rymer ◽

Shuang Li ◽

Patrick H. Pun ◽

Laine Thomas ◽

Tracy Y. Wang

Keyword(s):

Myocardial Infarction ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Racial Disparities ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Logistic Regression Models ◽

Black Patients ◽

Invasive Management ◽

White Patients

Background: Due to increased risks of contrast nephropathy, chronic kidney disease (CKD) can deter consideration of invasive management for patients with myocardial infarction (MI). Black patients have a higher prevalence of CKD. Whether racial disparities exist in the use of invasive MI management for patients with CKD presenting with MI is unknown. Methods: We examined 717 012 White and 99 882 Black patients with MI treated from 2008 to 2017 at 914 hospitals in the National Cardiovascular Data Registry Chest Pain—MI Registry. CKD status was defined as estimated glomerular filtration rate (eGFR) ≥90 mL/(min·1.73 m 2 ; no CKD), eGFR <90 but ≥60 (mild), eGFR <60 but ≥30 (moderate), and eGFR <30 or dialysis (severe). We used multivariable logistic regression models to examine the interaction of race and CKD severity in invasive MI management. Results: Among those with MI, Black patients were more likely than White patients to have CKD (eGFR <90; 61.4% versus 58.5%; P <0.001). Among those with MI and CKD, Black patients were more likely than White patients to have severe CKD (21.2% versus 12.4%; P <0.001). Patients with CKD were more likely than those without CKD to have diabetes or heart failure; Black patients with CKD were more likely to have these comorbidities when compared with White patients with CKD (all P <0.0001). Black race and CKD were associated with a lower likelihood of invasive management (adjusted odds ratio, 0.78 [95% CI, 0.75–0.81]; adjusted odds ratio, 0.72 [95% CI, 0.70–0.74]; P <0.001 for both). At eGFR levels ≥10, Black patients were significantly less likely than White patients to undergo invasive management. Conclusions: Black patients with MI and mild or moderate CKD were less likely to undergo invasive management compared with White patients with similar CKD severity. National efforts are needed to address racial disparities that may remain in the invasive management of MI.

Download Full-text

Tobacco Product Access Scenarios Influence Hypothetical Use Behaviors

Tobacco Regulatory Science ◽

10.18001/trs.7.3.4 ◽

2021 ◽

Vol 7 (3) ◽

pp. 184-202

Author(s):

Augustus M. White ◽

Deborah J. Ossip ◽

L. Morgan Snell ◽

Dongmei Li ◽

Cosima Hoetger ◽

...

Keyword(s):

Tobacco Use ◽

Tobacco Product ◽

Retail Stores ◽

Online Experiment ◽

Tobacco Products ◽

Visual Analog Scales ◽

Seemingly Unrelated Regressions

Objective: In this paper, we characterize how potential policies restricting access to tobacco products may impact use behaviors among adult, past 30-day, smokers and e-cigarette users. Methods: We conducted an online experiment with 820 smokers, e-cigarette users, and dual users (April 27-June 8, 2020). We randomized participants to one of 4 hypothetical access scenarios: (1) tobacco retail stores open + pharmacies open (TOPO); (2) tobacco stores open but favorite brand unavailable + pharmacies open (TOPO-NFB); (3) tobacco stores closed + pharmacies open (TCPO); and (4) tobacco stores closed + pharmacies closed (TCPC). Outcomes (measured on 0-100 visual analog scales) included the likelihood of quitting, reducing, switching brands or products, and finding another source of tobacco products. Seemingly unrelated regressions tested for associations between access scenarios and prospective tobacco use behaviors. Results: Participants in the TCPO and TOPO-NFB scenarios were more likely to reduce use, switch brands/products, and find another source (ps < .001) than those in the TOPO scenario. Dual and flavored product users were more likely to switch products (ps < .01). Conclusions: When tobacco retailers are closed, tobacco users may be more likely to quit and/or reduce use compared to when retailers are open. However, access restrictions could prompt users to switch tobacco brands/products or sources.

Download Full-text

Responses to the Physical Activity Guidelines and Dissemination Strategies for Behavior Change in a Representative Sample of US Adults

Journal of Physical Activity and Health ◽

10.1123/jpah.2021-0136 ◽

2021 ◽

pp. 1-10

Author(s):

Malorie Polster ◽

Erin E. Dooley ◽

Kate Olscamp ◽

Katrina L. Piercy ◽

April Oh

Keyword(s):

Physical Activity ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Information Source ◽

Population Based ◽

Multiple Sources ◽

Physical Activity Guidelines ◽

Logistic Regressions ◽

National Trends

Background: Dissemination of the Physical Activity Guidelines for Americans (Guidelines) is needed, but how individuals respond to the Guidelines is not well understood. This surveillance study describes US adults’ reported responses to and information sources for hearing about the Guidelines and explores relationships between how respondents heard about the Guidelines and their reported response(s). Methods: Data were analyzed from the population-based 2019 Health Information National Trends Survey 5 Cycle 3. Population-weighted proportions of response were calculated. Among those who had heard about the Guidelines, binary logistic regressions examined associations between the reported response(s) and the information source and number of sources reported. Results: The analytical sample included 5047 adults. Nearly 65% of US adults reported hearing about the Guidelines, and 29% reported a behavioral response (eg, increased physical activity). Hearing about the Guidelines through health professionals (adjusted odds ratio = 2.30, 95% confidence interval, 1.45–3.65) or social media (adjusted odds ratio = 1.89, 95% confidence interval, 1.20–2.96) (vs other sources) was associated with reporting increasing physical activity. Hearing from multiple sources (vs one source) was associated with reporting increasing physical activity (adjusted odds ratio = 1.97, 95% confidence interval, 1.18–3.31). Conclusion: Findings suggest dissemination of the Guidelines across multiple channels may promote greater changes in physical activity.

Download Full-text

E-cigarette and cigarette purchasing among young adults before and after implementation of California’s tobacco 21 policy

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055417 ◽

2020 ◽

pp. tobaccocontrol-2019-055417 ◽

Cited By ~ 3

Author(s):

Sara Schiff ◽

Fei Liu ◽

Tess Boley Cruz ◽

Jennifer B Unger ◽

Sam Cwalina ◽

...

Keyword(s):

Population Based ◽

Tobacco Product ◽

Cigarette Use ◽

Limited Data ◽

Tobacco Products ◽

Gas Stations ◽

The Past ◽

Before And After ◽

The Usa ◽

Vape Shops

BackgroundTobacco 21 (T21) laws, which raise the minimum legal age of sale of tobacco products to 21, have been proposed and implemented in states and cities across the USA. However, limited data are available on the effect of T21 laws on youth tobacco purchasing behaviours and access to tobacco products.MethodsParticipants in a population-based prospective cohort in southern California completed questionnaires before (n=1609, age=18–19 y) and after (n=1502, age=19–20 y) T21 was implemented in California (June 2016). We examined the prevalence of past 30-day cigarette and e-cigarette use, and among past 30-day users, purchase location of tobacco products before (pre-) versus after (post-) T21. We also examined whether, post-T21, participants were refused purchase of tobacco products due to their age, and the perceived relative ease of purchasing cigarettes and e-cigarettes (vs pre-T21).ResultsNegligible changes in cigarette and e-cigarette use were observed pre-T21 versus post-T21. At both time points, the majority of past 30-day users purchased cigarettes from gas stations and e-cigarettes from vape shops. Post-T21, the proportion of participants who reported purchasing cigarettes at gas stations decreased. Post-T21, most past 30-day cigarette or e-cigarette users were not refused purchase of cigarettes (65.4%) or e-cigarettes (82.0%) in the past 30 days, despite being under 21; half of the participants felt it was harder to purchase cigarettes (54.3%) and e-cigarettes (43.6%) post-T21.ConclusionPost-T21, few participants were refused purchase of any tobacco product, despite the illegality of such sales. Better enforcement of T21 is needed to improve the efficacy of T21 legislation.

Download Full-text

Associations Between Plasma Ceramides and Cerebral Microbleeds or Lacunes

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.120.314796 ◽

2020 ◽

Vol 40 (11) ◽

pp. 2785-2793

Author(s):

Eseosa T. Ighodaro ◽

Jonathan Graff-Radford ◽

Jeremy A. Syrjanen ◽

Hai H. Bui ◽

Ronald C. Petersen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Odds Ratio ◽

Small Vessel Disease ◽

High Plasma ◽

Population Based ◽

Cerebral Microbleeds ◽

Small Vessel ◽

Resonance Imaging ◽

Logistic Regression Models

Objective: High plasma ceramide levels and ratios are associated with poor outcomes in individuals with cardiovascular disease; less is known about their relation to cerebral small vessel disease. We examined whether high plasma ceramide levels or ratios were associated with cerebral microbleeds (CMBs) and lacunes and whether associations differ by sex. Approach and Results: We included 548 participants enrolled in the MCSA (Mayo Clinic Study of Aging) with concurrent plasma ceramide assays and magnetic resonance imaging. CMBs were quantified on T2* magnetic resonance imaging and lacunes on T2 fluid-attenuated inversion recovery magnetic resonance imaging. Fasting plasma ceramides were assayed using liquid chromatography-electrospray ionization tandem mass spectrometry. We used logistic regression models adjusting for age, sex, hypertension, and diabetes mellitus to examine the relationship between ceramides and presence of a lacune; hurdle models were used for presence and number of CMBs. Each SD increase in the log ceramide C16:0/24:0 ratio was associated with greater odds of a CMB (odds ratio, 1.28 [95% CI, 1.01–1.64]). There was an interaction between sex and the ceramide C16:0/24:0 ratio ( P =0.049). The association between this ratio and presence of a CMB was stronger for women (odds ratio, 1.87 [95% CI, 1.20–3.00]) than men (odds ratio, 1.09 [95% CI, 0.80–1.46]). Several ceramides and all ceramide ratios were associated with number of CMBs. We did not find associations between plasma ceramides and lacunes. Conclusions: In a population-based sample, the plasma ceramide C16:0/24:0 ratio was associated with CMBs and was stronger for women. Plasma ceramides are differentially associated with cerebral small vessel pathologies.

Download Full-text