Association between school-based tobacco retailer exposures and young adolescent cigarette, cigar and e-cigarette use

BackgroundAssociations between retail tobacco availability and tobacco use have been mixed. This study examined associations between school-based retail environment exposures and current use of cigarettes, cigar products and e-cigarettes among middle school youth in Cleveland, OH.MethodsRetailers selling tobacco products were identified using the 2015 Cleveland Food Retail Database (n=639 stores). Youth survey data were drawn from the 2016 Cleveland Youth Risk Behavior Survey, administered to all 7th/8th graders across the Cleveland Metropolitan School District (n=3778, response rate=83.0%). Past 30-day cigarette, cigar product and e-cigarette use were assessed. Student demographics, number of days walking to/from school each week and number of times youth stopped at a retailer to/from school each week were included. For each school (n=63), tobacco retail density (TRD) and proximity (TRP) to nearest retailer were calculated for each product. Multiple regression analysis assessed associations between retail exposures and youth tobacco use.ResultsAcross all schools, 3.9%, 10.2% and 8.6% of students currently use cigarettes, cigar products and e-cigarettes, respectively, and 15.2% currently use at least one tobacco product. TRD and TRP were not associated with current use; frequency of walking to school and stopping at retailers were strongly associated with current use.ConclusionsAlthough TRD and TRP were not significantly associated with tobacco product use, youth who reported regularly walking to/from school or who reported stopping at a retail store before/after school were significantly more likely to be a current tobacco product user. This may be due to increased exposure to exterior and point-of-sale marketing.

Download Full-text

Discordance between perceived and actual tobacco product use prevalence among US youth: a comparative analysis of electronic and regular cigarettes

Tobacco Control ◽

10.1136/tobaccocontrol-2017-054113 ◽

2018 ◽

Vol 28 (2) ◽

pp. 212-219 ◽

Cited By ~ 1

Author(s):

Israel Terungwa Agaku ◽

Satomi Odani ◽

David Homa ◽

Brian Armour ◽

Rebecca Glover-Kudon

Keyword(s):

Tobacco Use ◽

Electronic Cigarettes ◽

Statistical Significance ◽

Tobacco Product ◽

Cigarette Use ◽

Cross Sectional ◽

Media Messages ◽

School Based ◽

Nationally Representative ◽

Actual Prevalence

ImportanceTwo components of social norms—descriptive (estimated prevalence) and injunctive (perceived acceptability)—can influence youth tobacco use.ObjectiveTo investigate electronic cigarettes (e-cigarette) and cigarette descriptive norms and measure the associations between overestimation of e-cigarette and cigarette prevalence and tobacco-related attitudes and behaviours.DesignCross-sectional.SettingSchool-based, using paper-and-pencil questionnaires.ParticipantsUS 6th-12th graders participating in the 2015 (n=17 711) and 2016 (n=20 675) National Youth Tobacco Survey.ExposureStudents estimated the percent of their grade-mates who they thought used e-cigarettes and cigarettes; the discordance between perceived versus grade-specific actual prevalence was used to categorise students as overestimating (1) neither product, (2) e-cigarettes only, (3) cigarettes only or (4) both products.OutcomesProduct-specific outcomes were curiosity and susceptibility (never users), as well as ever and current use (all students). Descriptive and multivariable logistic regression analyses were performed. Statistical significance was at P<0.05. Data were weighted to be nationally representative.ResultsMore students overestimated cigarette (74.0%) than e-cigarette prevalence (61.0%; P<0.05). However, the associations between e-cigarette-only overestimation and e-cigarette curiosity (adjusted OR (AOR)=3.29), susceptibility (AOR=2.59), ever use (AOR=5.86) and current use (AOR=8.15) were each significantly larger than the corresponding associations between cigarette-only overestimation and cigarette curiosity (AOR=1.50), susceptibility (AOR=1.54), ever use (AOR=2.04) and current use (AOR=2.52). Despite significant declines in actual e-cigarette use prevalence within each high school grade level during 2015–2016, perceived prevalence increased (11th and 12th grades) or remained unchanged (9th and 10th grades).ConclusionsFour of five US students overestimated peer e-cigarette or cigarette use. Counter-tobacco mass media messages can help denormalise tobacco use.

Download Full-text

Perception and Current Use of E-cigarettes Among Youth in China

Nicotine & Tobacco Research ◽

10.1093/ntr/nty145 ◽

2018 ◽

Vol 21 (10) ◽

pp. 1401-1407 ◽

Cited By ~ 12

Author(s):

Lin Xiao ◽

Mark Parascandola ◽

Congxiao Wang ◽

Yuan Jiang

Keyword(s):

Middle School ◽

Middle School Students ◽

Tobacco Use ◽

Tobacco Product ◽

Cigarette Use ◽

School Students ◽

Factors Associated ◽

Nationally Representative ◽

Never Smokers ◽

The Relationship

Abstract Introduction This study provides nationally representative estimates of electronic cigarette (e-cigarette) use among youth in China and explores the factors associated with awareness and use of e-cigarettes and the relationship between e-cigarette and conventional tobacco use. Methods This study examined data from the Global Youth Tobacco Survey, which was completed by 155 117 middle school students (51.8% boys and 48.2% girls) in China, and employed a multistage stratified cluster sampling design. For data analysis, SAS 9.3 complex survey procedures were used, and logistic regression was used to explore factors associated with e-cigarette use and the relationship between e-cigarette and conventional tobacco use. Results About 45.0% of middle school students had heard of e-cigarettes, but only 1.2% reported using e-cigarettes in the last 30 days. Among never-smokers, e-cigarette users were more likely to intend to use a tobacco product in the next 12 months than nonusers (adjusted odds ratio [OR] = 6.970, 95% confidence interval [CI] = 4.474% to 10.857%), and more likely to say that they would enjoy smoking a cigarette (adjusted OR = 14.633, 95% CI = 11.328% to 18.902%). E-cigarette use was associated with previous experimentation with cigarette smoking (OR = 3.2), having noticed tobacco advertising in the past 30 days (OR = 2.7), having close friends who smoke (OR = 1.4), and thinking tobacco helps people feel more comfortable in social situations (OR = 3.3) and makes young people look more attractive (OR = 1.3). Conclusions E-cigarette use among youth in China remains low but awareness is high. E-cigarette use was associated with increased intentions to use tobacco. Enhanced prevention efforts are needed targeting e-cigarette use among youth. Implications This study is the first nationally representative survey of e-cigarette use among youth in China. It found that among middle school students, prevalence of e-cigarette use is 1.2% and prevalence of e-cigarette awareness is 45.0%. Chinese youths use e-cigarettes as a tobacco product rather than an aid to quitting. Among never-smokers, e-cigarette users were more likely to have intentions to use a tobacco product in the next 12 months, more likely to use a tobacco product offered by their best friends and enjoy smoking a cigarette than nonusers.

Download Full-text

Abstract P087: Youth Tobacco Users Perceive Less E-Cig Harm

Circulation ◽

10.1161/circ.137.suppl_1.p087 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Delvon T Mattingly ◽

Lindsay K Tompkins ◽

Clara G Sears ◽

Kandi L Walker ◽

Joy L Hart

Keyword(s):

High School Students ◽

Tobacco Use ◽

Rural Areas ◽

Multinomial Logistic Regression ◽

Health Problems ◽

Tobacco Product ◽

Scientific Uncertainty ◽

Cigarette Use ◽

School Students ◽

Tobacco Products

Introduction: In Appalachia, youth tobacco use rates exceed the national average, and youth in these rural areas are increasingly aware of new and emerging tobacco products, such as e-cigarettes. Given that e-cigarettes are a commonly used tobacco product by youth, additional inquiry is needed to better understand both youth product perceptions and use patterns, especially in communities with entrenched acceptance of tobacco. Study Aim and Hypothesis: Our aim is to examine the prevalence of conventional tobacco and e-cigarette use among Appalachian youth and to examine associations between use and tobacco harm perceptions. We hypothesized that conventional tobacco users would be less likely than non-users to perceive e-cigarette use as harmful and that e-cigarette users would be less likely than non-users to perceive e-cigarette use as harmful. Methods: A survey of middle and high school students (n=1,008) was conducted in rural Appalachia. The primary outcome in this analysis, tobacco use, was categorized as never user, conventional tobacco only user (cigarettes or smokeless), or e-cigarette only user. Descriptive characteristics were compared among the three use groups. Relationships between harm perceptions and tobacco product use were assessed using multinomial logistic regression models adjusted for age, race, gender, and grade level. Results: Nearly one-fourth (23%) of the participants had tried e-cigarettes. Compared to never users, conventional users were more likely to indicate that e-cigarettes did not cause: (1) health problems (OR: 1.65; CI: 1.075-2.521) or (2) addiction (OR: 1.63; CI: 1.064-2.496). Youth who indicated e-cigarettes do not cause health problems were more likely to be e-cigarette users than non-e-cigarette users (OR: 2.04, CI: 1.460-2.838), and youth who indicated smoking does not cause addiction were more likely to be conventional users than never or e-cigarette only users (OR: 1.96; CI: 1.181-3.262). Conclusions: In summary, youth who use conventional tobacco products or e-cigarettes are less likely to perceive e-cigarettes as harmful. These findings reinforce the need for vigilance in restricting youth access to tobacco products, increased emphasis on health campaigns that clarify scientific uncertainty surrounding tobacco safety, and regulation of e-cigarette marketing that targets youth.

Download Full-text

Current advances in research in treatment and recovery: Nicotine addiction

Science Advances ◽

10.1126/sciadv.aay9763 ◽

2019 ◽

Vol 5 (10) ◽

pp. eaay9763 ◽

Cited By ~ 14

Author(s):

Judith J. Prochaska ◽

Neal L. Benowitz

Keyword(s):

Clinical Features ◽

Tobacco Use ◽

Addiction Treatment ◽

Behavioral Treatment ◽

Tobacco Product ◽

Nicotine Addiction ◽

Evidence Based ◽

Cigarette Use ◽

New Directions ◽

Review Current

The health harms of combusted tobacco use are undeniable. With market and regulatory pressures to reduce the harms of nicotine delivery by combustion, the tobacco product landscape has diversified to include smokeless, heated, and electronic nicotine vaping products. Products of tobacco combustion are the main cause of smoking-induced disease, and nicotine addiction sustains tobacco use. An understanding of the biology and clinical features of nicotine addiction and the conditioning of behavior that occurs via stimuli paired with frequent nicotine dosing, as with a smoked cigarette, is important for informing pharmacologic and behavioral treatment targets. We review current advances in research on nicotine addiction treatment and recovery, with a focus on conventional combustible cigarette use. Our review covers evidence-based methods to treat smoking in adults and policy approaches to prevent nicotine product initiation in youth. In closing, we discuss emerging areas of evidence and consider new directions for advancing the field.

Download Full-text

Flavoured tobacco product restrictions in Massachusetts associated with reductions in adolescent cigarette and e-cigarette use

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056159 ◽

2021 ◽

pp. tobaccocontrol-2020-056159

Author(s):

Summer Sherburne Hawkins ◽

Claudia Kruzik ◽

Michael O'Brien ◽

Rebekah Levine Coley

Keyword(s):

Tobacco Control ◽

Tobacco Use ◽

Tobacco Product ◽

County Level ◽

Cigarette Use ◽

Youth Health ◽

Control Policies ◽

Tobacco Control Policies ◽

The Usa ◽

Adolescent Tobacco Use

BackgroundIn the USA, many states do not pre-empt municipalities from enacting stricter tobacco-control policies than state or federal laws. Several municipalities in Massachusetts have passed progressive local laws aimed at reducing adolescent tobacco use. We exploited this variability to examine the associations between county-level flavoured tobacco product restrictions, tobacco 21 policies and smoke-free laws prohibiting e-cigarettes with adolescent cigarette and e-cigarette use in Massachusetts, and to assess whether policy effects varied by age.MethodsWe conducted difference-in-differences models to link changes in county-level tobacco-control policies to changes in adolescents’ use of cigarettes and e-cigarettes using 2011–2017 biennial Massachusetts Youth Health Surveys.ResultsCounties with greater implementation of flavoured tobacco product restrictions were associated with a decrease in the level of cigarette use among users (incidence rate ratio −1.56; 95% CI −2.54 to −0.58). A significant interaction (p=0.03) revealed the largest reductions among 14 and 18 year olds. Increasing flavoured tobacco product restrictions were also associated with reductions in the likelihood of e-cigarette use (OR −0.87; 95% CI −1.68 to −0.06). Increasing tobacco 21 restrictions were associated with decreases in cigarette use only among 18 year olds, while there was no evidence of associations between smoke-free laws with use of either tobacco product.ConclusionsAdolescents in Massachusetts decreased their use of cigarettes and e-cigarettes in response to local restrictions that limited the sale of flavoured tobacco products to adult-only retail tobacco stores. Local legislation can reduce adolescent tobacco use and municipalities should enact stricter tobacco-control policies when not pre-empted by state law.

Download Full-text

Comparison of a General and Conditional Measure of E-Cigarette Harm Perceptions

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17145151 ◽

2020 ◽

Vol 17 (14) ◽

pp. 5151

Author(s):

Olivia A. Wackowski ◽

Michelle Jeong

Keyword(s):

Young Adults ◽

Risk Perception ◽

Best Practices ◽

Survey Data ◽

Tobacco Use ◽

Tobacco Product ◽

Conditional Measure ◽

Cigarette Use ◽

Exploratory Survey ◽

Highly Correlated

Measures of tobacco product harm perceptions are important in research, given their association with tobacco use. Despite recommendations to use more specific harm and risk perception measures, limited research exists comparing different wordings. We present exploratory survey data comparing young adults’ (ages 18–29) responses to a general e-cigarette harm perception measure (“How harmful, if at all, do you think vaping/using an e-cigarette is to a user’s health?”) with a more specific conditional measure, which personalized the behavior/harm (“imagine you vaped,” “your health”) and presented a specific use condition (exclusive daily vaping) and timeframe (10 years). Data were collected in January 2019 (n = 1006). Measures were highly correlated (r = 0.76, Cronbach’s α = 0.86), and most (65%) provided consistent responses, although more participants rated e-cigarettes as very or extremely harmful using the conditional (51.6%) versus the general (43.9%) harm measure. However, significant differences in harm ratings were not observed among young adults who currently vaped. Correlations between each harm perception measure and measures of e-cigarette use intentions were similar. More specifically worded harm perception measures may result in somewhat higher e-cigarette harm ratings than general measures for some young adults. Additional research on best practices for measuring e-cigarette and other tobacco harm perceptions is warranted.

Download Full-text

Positive Affect and Multiple-tobacco Product Use among Youth: A 3-year Longitudinal Study

American Journal of Health Behavior ◽

10.5993/ajhb.45.5.5 ◽

2021 ◽

Vol 45 (5) ◽

pp. 849-855

Author(s):

Dale S. Mantey ◽

Stephanie L. Clendennen ◽

Aslesha Sumbe ◽

Anna V. Wilkinson ◽

Melissa B. Harrell

Keyword(s):

Positive Affect ◽

Tobacco Use ◽

Multinomial Logistic Regression ◽

Tobacco Product ◽

Poor Mental Health ◽

Cigarette Use ◽

Logistic Regression Models ◽

Increased Risk ◽

Tenth Grade ◽

Race Ethnicity

Objectives: Multiple-tobacco product (MTP) use is common among adolescent tobacco users. Low positive affect is a risk factor for e-cigarette use and combustible tobacco smoking. In this study, we examine the longitudinal relationship between positive affect and MTP use in a diverse cohort of adolescents in Texas. Methods: We analyzed 6 waves of biennial data (fall 2014-spring 2017) from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were 3868 sixth-, eighth-, and tenth-grade students in urban Texas, at enrollment. Multinomial logistic regression models examined the longitudinal relationship between positive affect and categories of MTP use, controlling for sex, race/ethnicity, past 30-day alcohol use, cohort, survey wave, and peer tobacco use. Results: The sample was comprised of 4.6% single-product users, 1.7% dual-users, and 0.7% poly-users. Each unit decrease in positive affect was associated with increased risk for single- (RRR: 1.29; 95% CI: 1.16-1.44), dual- (RRR: 1.35; 95% CI: 1.11-1.64), and poly- (RRR: 1.98; 95% CI: 1.54-2.54) use, relative to non-use. Similarly, each unit decrease in positive affect was also associated with increased risk for poly-tobacco use relative to single- (RRR: 1.53; 95% CI: 1.19-1.97) and dual- (RRR: 1.47; 95% CI: 1.11-1.95) use. Positive affect did not differentiate between single- and dual-use. Conclusion: We observed a gradient relationship between low positive affect and greater number of tobacco products used. Findings reinforce the association between poor mental health and tobacco use during adolescence. Prevention efforts may need to incorporate methods of addressing low positive affect.

Download Full-text

Abstract 17227: Tobacco Use Prevalence and Transitions Among Adults With a History of Cardiovascular Disease

Circulation ◽

10.1161/circ.142.suppl_3.17227 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Cristian Zamora ◽

Lindsay M Reynolds ◽

Un Jung Lee ◽

Andrew Stokes ◽

Benjamin Emelia J ◽

...

Keyword(s):

Cardiovascular Disease ◽

Tobacco Use ◽

Young Male ◽

Cardiovascular Effects ◽

Tobacco Product ◽

Self Report ◽

Health Study ◽

Cigarette Use ◽

Dual Use ◽

Quitting Smoking

Introduction: Although tobacco product transitions have been characterized in the general population, few studies have examined use in individuals with established cardiovascular disease (CVD). Methods: We examined tobacco use prevalence, and longitudinal patterns of tobacco product transitions in adult respondents (≥18 years) of the 2013-2014 (Wave 1) through 2016-2018 (Wave 4) Population Assessment of Tobacco and Health Study. Analysis was restricted to adults with prevalent CVD. Prevalent CVD was defined based on self-report at Wave 1 to the question from a health professional if she/he had: 1) a heart attack, 2) heart failure, 3) a stroke, or 4) some other heart condition. Factors associated with tobacco use (cigarette, e-cigarette, cigar, pipe tobacco, hookah, smokeless, dissolvable, or snus) and tobacco product transitions were investigated using logistic regression. Results: At Wave 1, 28.8% reported tobacco use among adults with CVD, the most commonly product was cigarettes (82.8%), followed by use of any type of cigar (49%) and e-cigarette use (23.2%), including 5.4% reporting dual use of cigarettes and e-cigarettes. E-cigarette use without concurrent cigarette use was uncommon (1.1%). Young male with lower level of education and lack of knowledge about the association between smoking and heart disease, were associated with tobacco use. Transition rates reported between Waves 1 and 4 demonstrate decreased cigarette use over time, with increased use of e-cigarette but less dual use. Male with prevalent CVD were less likely to use e-cigarettes compared to female (OR = 0.5, 95% CI: 0.4 - 0.8). Conclusions: Despite known harmful cardiovascular effects, almost a quarter of adults with prevalent CVD smoke cigarettes and few are quitting smoking.

Download Full-text

E-cigarette Use, Tobacco Product Polyuse, and Motivations for Use among Baltimore Young Adults

Health Behavior and Policy Review ◽

10.14485/hbpr.6.5.2 ◽

2019 ◽

Vol 6 (5) ◽

pp. 427-437

Author(s):

Daisy Le ◽

Meghan B. Moran ◽

Rebkha Atnafou ◽

Pamela A. Matson ◽

Miranda R. Jones ◽

...

Keyword(s):

Young Adults ◽

Tobacco Use ◽

Text Messaging ◽

Risk Perceptions ◽

Tobacco Cessation ◽

Tobacco Product ◽

Urban Setting ◽

Cigarette Use ◽

Use Patterns ◽

History Of

Objective: We examined reasons for e-cigarette use, tobacco product polyuse, and tobacco cessation interest among tobacco-using young adults from an urban setting. Methods: Participants (N = 97) completed a risk factor survey. Descriptive statistics and prevalence estimates of polytobacco use patterns, motivations for tobacco use, tobacco cessation interest, and beliefs and risk perceptions about tobacco use were explored. Results: All participants had a history of polyuse, and 85% were current polyusers. Stress was the primary reason reported for tobacco use. Compared to single-product users, current polyusers also were more likely to mention environment and cheap cost as reasons for use. Most participants perceived cigarettes to be as addictive as cocaine or heroin, although this perception was less common among e-cigarette users than non-users. Among study participants, 59% reported wanting to stop using tobacco completely. Among current polyusers, those that used e-cigarettes were more likely to report cessation attempts during the past year and express interest in enrolling in a quit smoking text messaging program. Conclusion: In our sample there was a high prevalence of polytobacco product use and complex tobacco use patterns among young adults, both in and out of college, from an urban community.

Download Full-text

E-Cigarettes and National Adolescent Cigarette Use: 2004—2014

10.1542/9781610022743-e_cigarettes_and_national ◽

2017 ◽

pp. 114-123

Author(s):

Lauren M. Dutra ◽

Stanton A. Glantz

Keyword(s):

Cigarette Smoking ◽

Interrupted Time Series ◽

The United States ◽

Tobacco Product ◽

Cigarette Use ◽

Cross Sectional ◽

School Based ◽

The Us ◽

Psychosocial Model ◽

Nationally Representative

BACKGROUND E-cigarette use is rapidly increasing among adolescents in the United States, abstract with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007. METHODS Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004–2014 National Youth Tobacco Surveys (samples ranged from 16 614 in 2013 to 25 324 in 2004). Analyses were conducted by using interrupted time series of ever (≥1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004–2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011–2014 samples. RESULTS Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette–only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers. CONCLUSIONS The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette–only users would be unlikely to have initiated tobacco product use with cigarettes.

Download Full-text