Who Purchases Tobacco Online? Findings from Waves 1 and 4 of the Population Assessment of Tobacco and Health Study

Objectives: We examined the prevalence of and factors associated with usually purchasing tobacco online. Methods: We analyzed Waves 1 (2013-14) and 4 (2016-17) of the US Population Assessment of Tobacco and Health adult (18+) and youth (12-17) studies: 15,450 adults and 495 youth in 2013-14 and 15,037 adults and 465 youth in 2016-17. Z-tests compared the prevalence of usually purchasing tobacco online between waves and weighted multivariable regressions identified associations between purchasing online and sociodemographics. Results: The prevalence of usually purchasing tobacco online increased from 2.5% to 3.3% among adults (p < .05) and from 2.5% to 4.4% among youth (p < .05), generalizing to a US population of 2,000,000 adults and 35,000 youth. E-cigarettes and cigars and e-cigarettes and waterpipe tobacco were the most common products among adults and youth, respectively. Men, adults with greater education, adults with higher income, and non-Hispanic black youth had greater odds of purchasing tobacco online (p < .05). Conclusions: Usually purchasing tobacco online remains low, although ever purchasing was not assessed. Efforts should be made to expand Internet tobacco purchasing surveillance and extend and enforce restrictions broadly across tobacco products to reduce youth access.

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Waterpipe tobacco package warning exposure’s impact on risk perceptions and use among young adults in the USA: a longitudinal analysis of the population assessment of tobacco and health study

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054562 ◽

2018 ◽

Vol 28 (e1) ◽

pp. e16-e23 ◽

Cited By ~ 5

Author(s):

Jessica L King ◽

Beth A Reboussin ◽

Jennifer Cornacchione Ross ◽

Erin L Sutfin

Keyword(s):

Young Adult ◽

Risk Perceptions ◽

Health Study ◽

Regression Analyses ◽

Population Assessment ◽

High Exposure ◽

Factors Associated ◽

The Usa ◽

Nationally Representative ◽

Waterpipe Use

BackgroundAlthough Food and Drug Administration (FDA)-mandated waterpipe tobacco warnings were not required until August 2018, some waterpipe tobacco packaging (WTP) sold in the USA, contained warnings prior to this date. We examined the prevalence of WTP warning exposure and whether exposure influenced risk perceptions or use among young adult (aged 18–24 years) current waterpipe users.MethodsWe used data from waves 1 (2013–2014) and 2 (2014–2015) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adults and youth. We conducted logistic regression analyses to identify factors associated with wave 1 warning exposure, and whether wave 1 WTP warning exposure predicted wave 2 relative risk perceptions and waterpipe use.ResultsMore than one-third of our sample (35.9%, 95% CI 33.5 to 38.4) reported past-month WTP warning exposure. Exposure was higher among males (adjusted OR (AOR)=1.34, 95% CI 1.04 to 1.72), those who usually do not share the waterpipe (AOR=3.10, 95% CI 1.45 to 6.60), those who purchased waterpipe tobacco (AOR=1.73, 95% CI 1.28 to 2.34), and those with a regular brand (AOR=1.84, 95% CI 1.26 to 2.68). Those exposed to WTP warnings at wave 1 were more likely than those not exposed to perceive waterpipe tobacco to be as or more harmful than cigarettes at wave 2 (AOR=1.35, 95% CI 1.02 to 1.78). There was no association between wave 1 WTP exposure and wave 2 waterpipe use.ConclusionsMore than one-third of US young adult current waterpipe users reported WTP warning exposure prior to FDA-mandated warning implementation. Findings suggest the mandated warning may result in high exposure among users; it will be critical to assess exposure’s impact on risk perceptions and behaviour after FDA-mandated warnings are implemented.

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4219 Discrepancies in flavor preferences among adult ever users of various tobacco products in the US – Findings from The Population Assessment of Tobacco and Health Study (2015-2016)

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.175 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 47-48

Author(s):

Liane M Schneller ◽

Dongmei Li ◽

Zahíra Quiñones-Tavárez ◽

Maciej Goniewicz ◽

Amanda Quisenberry ◽

...

Keyword(s):

Smoking Cessation ◽

Conflict Of Interest ◽

The Other ◽

Health Study ◽

Flavor Preference ◽

Tobacco Products ◽

Population Assessment ◽

Study Results ◽

Research Grant ◽

Flavored Tobacco

OBJECTIVES/GOALS: Flavorings differ between brands and tobacco products, potentially altering the sensory perceptions. This study aimed to examine discrepancies in flavor preference across various non-cigarette tobacco products among a national representative sample of US adult regular tobacco users. METHODS/STUDY POPULATION: Data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. Weighted prevalence of flavor preference for various tobacco products, including electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos/filtered cigars, hookah and snus/smokeless, was presented for 9,037 adult current and new former users of multiple flavored tobacco products. Within-subject flavor discrepancies were assessed using generalized estimating equations (GEE) models considering the complex sampling design of the PATH study. RESULTS/ANTICIPATED RESULTS: Most regular users of a flavored tobacco products reported using one flavor category per product. Fruit flavors, followed by tobacco, were the most common flavor categories among ENDS (32% and 25%, respectively) and hookah users (44% and 36%, respectively). Tobacco flavor was the most common among regular users of traditional cigars (80%), cigarillos/filtered cigars (55%), and smokeless tobacco (79%). Polytobacco users of ENDS and traditional cigars had the largest discrepancy, where about 68-76%% used different flavor categories when switching products. Conversely, polytobacco users of traditional cigars and cigarillos/filtered cigars had the lowest discrepancy (23-25%). DISCUSSION/SIGNIFICANCE OF IMPACT: Many consumers of multiple tobacco products had different flavor preferences when switching between products. In the event of a partial or full flavor ban for ENDS, these findings raise questions about consumer loyalty to a particular tobacco product or a particular flavor category. Conflict of Interest Description: MLG serves as a paid consultant for Johnson & Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare. CONFLICT OF INTEREST DESCRIPTION: MLG serves as a paid consultant for Johnson & Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare.

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4179 Use of tobacco products and their association with wheezing among adult current tobacco users in the US – Findings from The Population Assessment of Tobacco and Health Study (2015-2016)

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.188 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 52-52

Author(s):

Liane M Schneller ◽

Zahíra Quiñones-Tavárez ◽

Maciej Goniewicz ◽

Zidian Xie ◽

Scott McIntosh ◽

...

Keyword(s):

Respiratory Symptoms ◽

Population Data ◽

Health Study ◽

Cross Sectional ◽

Tobacco Products ◽

Population Assessment ◽

Current Cigarette ◽

Us Findings ◽

Noxious Chemicals ◽

Current Tobacco

OBJECTIVES/GOALS: Wheezing has been shown to be associated with use of cigarettes, and more recently, electronic nicotine delivery systems (ENDS). This study assessed the association of poly use of tobacco products with wheezing among a national representative sample of US adult current tobacco users. METHODS/STUDY POPULATION: Data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. Weighted prevalences of self-reported wheezing and related respiratory symptoms for non-users compared to users of cigarettes, ENDS, cigars, and any combination of these products (poly use of tobacco products) were presented for 28,082 adults. The cross-sectional association of tobacco use with self-reported wheezing and other related respiratory symptoms was assessed using weighted multivariable and ordinal logistic regression with consideration of complex sampling design. RESULTS/ANTICIPATED RESULTS: Most adults who reported on wheezing symptoms did not currently use cigarettes, ENDS or cigars (79%), 15% used cigarettes, 3% used a combination of cigarettes, ENDS and cigars, 1% used ENDS, and 1% used cigars. Significantly higher odds of ever had wheezing or whistling in chest at any time in the past was observed among current cigarette (adjusted OR: 2.62, 95%CI: 2.35, 2.91), ENDS (1.49, 95%CI: 1.14, 1.95), and poly users (2.67, 95%CI: 2.26, 3.16) compared to non-users. No differences were seen for cigar use. Polytobacco use was associated with a higher odds of ever wheezing when compared to ENDS (1.61, 95%CI: 1.19, 2.17) and cigar use (2.87, 95%CI: 1.93, 4.26), but not cigarettes. DISCUSSION/SIGNIFICANCE OF IMPACT: Wheezing is associated with the use of cigarettes, ENDS, or any combination of cigarette, ENDS and cigars likely due to the inhalation of noxious chemicals and gases found in the smoke of cigarettes and ENDS that are likely to increase the odds of experiencing wheezing. CONFLICT OF INTEREST DESCRIPTION: MLG serves as a paid consultant for Johnson & Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare.

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Use of Flavored E-Cigarettes and the Type of E-Cigarette Devices Used among Adults and Youth in the US—Results from Wave 3 of the Population Assessment of Tobacco and Health Study (2015–2016)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16162991 ◽

2019 ◽

Vol 16 (16) ◽

pp. 2991 ◽

Cited By ~ 19

Author(s):

Liane M. Schneller ◽

Maansi Bansal-Travers ◽

Maciej L. Goniewicz ◽

Scott McIntosh ◽

Deborah Ossip ◽

...

Keyword(s):

United States ◽

Smoking Cessation ◽

Drug Administration ◽

Smoking Status ◽

Food And Drug Administration ◽

The United States ◽

Health Study ◽

Population Assessment ◽

The Us

The United States (U.S.) Food and Drug Administration has expressed concern about flavored e-cigarettes (e.g., JUUL brand) because they are appealing to youth who may be unaware that the product is addictive. The Population Assessment of Tobacco and Health Study Wave 3 provided data on flavor categories, type of e-cigarette product, and smoking status among past 30-day youth and adult e-cigarette users in the US. Most past 30-day youth and adult users reported using only one flavor category, with fruit (53% youth, 31% adult) being the most commonly reported category. Adults were far more likely to report using tobacco flavor alone, compared to any other individual flavor category or flavor category combinations (OR: 21.08, 95%CI: 5.92, 75.12). Whereas, youth were more likely to report using multiple flavor categories (OR: 2.03, 95%CI: 1.55, 2.65), with the most reported pairing being fruit and candy (36%). The variety of flavors on the market appeals to consumers of all ages. Although most past 30-day e-cigarette users reported only one flavor category, non-tobacco flavors were far more common among youth. Differences in flavor preferences among adult versus youth vapers may have implications for the role of flavors in both the initiation of youth vaping and adult vaping for smoking cessation.

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Changes in Cigarettes per Day and Biomarkers of Exposure Among US Adult Smokers in the Population Assessment of Tobacco and Health Study Waves 1 and 2 (2013–2015)

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa038 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1780-1787

Author(s):

Brian L Rostron ◽

Catherine G Corey ◽

Joanne T Chang ◽

Dana M van Bemmel ◽

Mollie E Miller ◽

...

Keyword(s):

Disease Risk ◽

Smoking Status ◽

Study Data ◽

Health Study ◽

Tobacco Exposure ◽

Cigarette Smokers ◽

Population Assessment ◽

Biomarker Of Exposure ◽

Biomarkers Of Exposure ◽

The Us

Abstract Introduction Some studies have found some reduction in tobacco exposure and tobacco-related disease risk with decreased numbers of cigarettes smoked per day (CPD), but biomarker of exposure estimates by change in CPD are generally unavailable for the US population. Methods We analyzed biomarker of exposure data by smoking status from over 1100 adult exclusive daily cigarette smokers in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study who were either exclusive daily smokers or had quit tobacco use entirely at Wave 2. Wave 1 smoking categories consisted of “very light” (1–4 CPD), “light” (5–9 CPD), “moderate” (10–19 CPD), and “heavy” (20+ CPD), and Wave 2 categories were “quitters” (stopped smoking entirely), exclusive cigarette “reducers” (CPD decreased ≥ 50%), “maintainers” (CPD within 50%–150% of Wave 1 value), and “increasers” (CPD increased ≥ 50%). Results Complete quitters had significantly lower levels of TNE-2, NNAL, NNN, 2-Fluorene, HPMA, CYMA, and MHB3 at Wave 2 for all Wave 1 CPD categories, and decreases were often large. Moderate “reducers” had lower levels of NNAL and 1-Hydroxypyrene at Wave 2, and heavy “reducers” had lower levels of NNAL, 2-Fluorene, and MHB3. Light “increasers” had higher levels of TNE-2, NNAL, 2-Fluorene, CYMA, and cadmium at Wave 2, and heavy “increasers” had higher levels of NNAL and HPMA. Conclusions Smoking “reducers” and “increasers” had changes in some biomarker of tobacco exposure levels, but reductions were much greater and more consistent for complete quitters. Implications PATH longitudinal cohort study data show that some exclusive daily cigarette smokers increase or decrease CPD over time. These differences may result in moderate changes in the levels of some biomarkers such as NNAL. Even so, however, reductions in biomarker levels are much greater with complete smoking cessation.

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Racial/Ethnic Differences in Associations of Noncigarette Tobacco Product Use with Subsequent Initiation of Cigarettes in US Youths

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa170 ◽

2020 ◽

Author(s):

Andrew Stokes ◽

Anna E Wilson ◽

Dielle J Lundberg ◽

Wubin Xie ◽

Kaitlyn M Berry ◽

...

Keyword(s):

Policy Development ◽

Black Youth ◽

Critical Role ◽

Health Study ◽

Hispanic Youth ◽

Cigarette Use ◽

Tobacco Products ◽

Product Use ◽

Prior Use ◽

Racial Ethnic

Abstract Introduction Understanding which noncigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco related health disparities. Methods We used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1-4. The sample was a dynamic cohort of cigarette-naïve youth aged 12-17 years. Mixed effects models were used to assess noncigarette product [e-cigarette, cigar product, or other product] use with cigarette use over 1-year intervals. Results Of the 28,788 observations pooled across waves 1-4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow up were higher among youth with prior use of e-cigarettes (OR, 2.76; 95% CI, 2.21-3.45), cigars (OR, 2.00; 95% CI, 1.42-2.80), or other products (OR, 1.66; 95% CI, 1.28-2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth. Conclusions Prior use of e-cigarettes, cigars, and other noncigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use). Implications Our findings suggest that previous studies on effects of noncigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black vs. white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of noncigarette tobacco products on cigarette initiation should consider cigar and other noncigarette products as well as e-cigarettes.

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Youth Access to Tobacco Products in the United States: Findings From Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health Study

Nicotine & Tobacco Research ◽

10.1093/ntr/nty238 ◽

2018 ◽

Vol 21 (12) ◽

pp. 1695-1699 ◽

Cited By ~ 9

Author(s):

Susanne Tanski ◽

Jennifer Emond ◽

Cassandra Stanton ◽

Thomas Kirchner ◽

Kelvin Choi ◽

...

Keyword(s):

United States ◽

Electronic Cigarettes ◽

The United States ◽

Tobacco Product ◽

Tobacco Products ◽

Population Assessment ◽

Gas Stations ◽

Usual Source ◽

Convenience Stores ◽

The Us

Abstract Objectives Tobacco products in the US market are growing in diversity. Little is known about how youth access tobacco products given this current landscape. Methods Data were drawn from 15- to 17-year-olds from the Wave 1 youth sample of the US nationally representative Population Assessment of Tobacco and Health (PATH) Study. Past 30-day tobacco users were asked about usual sources of access to 12 different tobacco products, and if they had been refused sale because of their age. Results Among 15- to 17-year-olds, social sources (“someone offered” or “asked someone”) were the predominant usual source of access for each tobacco product. “Bought by self” was the usual source of access for users of smokeless (excluding snus, 23.2%), cigarillos (21.0%), cigarettes (13.8%), hookah (12.0%), and electronic cigarettes (10.5%). Convenience stores and/or gas stations were the most often selected retail source for all products except hookah. Among youth who attempted purchase, 24.3% were refused sale of cigarettes, 23.9% cigarillos, and 13.8% smokeless tobacco. Conclusions Most 15- to 17-year-old tobacco users obtain tobacco products through social sources; however, among those who purchased tobacco, the majority report not being refused sale because of age. At the time of survey, cigarette and cigar sales to under 18 years were prohibited in all 50 states, and electronic cigarettes sales in 47 states and two territories. 2014 Annual Synar Reports signaled increasing trends in retail violations of state and/or district laws prohibiting tobacco product sales to under 18 years. Monitoring illicit youth sales, conducting compliance check inspections, and penalizing violations remain important to reduce youth tobacco access at retail venues. Implications Access to the spectrum of tobacco products by youth in the United States remains predominantly through social sources. However, of the minority of youth tobacco users in 2014 who purchased tobacco themselves, a few reported being refused sale: Convenience stores and/or gas stations were the most common retail source for tobacco products. The strategies of monitoring illicit youth sales, conducting compliance checks, and penalizing violations remain important to reduce youth tobacco access at retail venues. Limiting sources of youth tobacco access remains an important focus to reduce the burden of tobacco on the public health.

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Flavor Inconsistencies between Flavored Tobacco Products among US Adults

American Journal of Health Behavior ◽

10.5993/ajhb.44.5.6 ◽

2020 ◽

Vol 44 (5) ◽

pp. 617-630

Author(s):

Liane M. Schneller ◽

Dongmei Li ◽

Zahíra Quiñones Tavárez ◽

Maciej L. Goniewicz ◽

Amanda J. Quisenberry ◽

...

Keyword(s):

Consumer Preferences ◽

Health Study ◽

Future Research ◽

Flavor Preference ◽

Cigarette Tobacco ◽

Tobacco Products ◽

Population Assessment ◽

Potential Benefits ◽

Flavored Tobacco

Objective: Banning flavors in some tobacco products, while allowing them in others, may shift consumer preferences towards products in which flavors are still allowed. In this study, we examine flavor popularity and inconsistencies in flavor preference across non-cigarette tobacco products among US adults. Methods: We used data from the Population Assessment of Tobacco and Health Study Wave 3 to assess the prevalence of flavor preference for users of non-cigarette tobacco products (N = 9037), as well as flavor inconsistencies between products among polyusers (N = 3183). Results: Most users of flavored tobacco products reported using one flavor category per product. Fruit and tobacco were among the most commonly used flavor categories of ENDS, hookah, traditional cigars, and cigarillo/filtered cigars. Menthol/mint was the most common flavor among snus/smokeless users. Polyusers of ENDS and traditional cigars had the largest inconsistency, where about 68%-76% used different flavors across products. Conversely, polyusers of traditional cigars and cigarillos/filtered cigars had the lowest inconsistency (25%-28%). Conclusions: Flavor preferences differed according to product, suggesting that consumers are not likely to switch across products to maintain a flavor preference. Future research should assess flavor preferences prospectively to improve understanding of the potential benefits of flavor bans.

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