Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study (Preprint)

BACKGROUND The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement. OBJECTIVE The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies. METHODS Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status. RESULTS The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7% vs 66.4%, <i>P</i>=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one’s own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities. CONCLUSIONS Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one’s own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment.

Balancing Consideration of the Risks and Benefits of E-Cigarettes

The topic of e-cigarettes is controversial. Opponents focus on e-cigarettes’ risks for young people, while supporters emphasize the potential for e-cigarettes to assist smokers in quitting smoking. Most US health organizations, media coverage, and policymakers have focused primarily on risks to youths. Because of their messaging, much of the public—including most smokers—now consider e-cigarette use as dangerous as or more dangerous than smoking. By contrast, the National Academies of Science, Engineering, and Medicine concluded that e-cigarette use is likely far less hazardous than smoking. Policies intended to reduce adolescent vaping may also reduce adult smokers’ use of e-cigarettes in quit attempts. Because evidence indicates that e-cigarette use can increase the odds of quitting smoking, many scientists, including this essay’s authors, encourage the health community, media, and policymakers to more carefully weigh vaping’s potential to reduce adult smoking-attributable mortality. We review the health risks of e-cigarette use, the likelihood that vaping increases smoking cessation, concerns about youth vaping, and the need to balance valid concerns about risks to youths with the potential benefits of increasing adult smoking cessation. (Am J Public Health. Published online ahead of print August 19, 2021: e1–e12. https://doi.org/10.2105/AJPH.2021.306416 )

Smoking Habits and the Influence of War on Cigarette and Shisha Smoking in Syria

Background: Tobacco smoking is a major risk factor for various preventable medical conditions. Our present study aimed at assessing Shisha and cigarette smoking in a sample of the Syrian population as well as assessing the interactions between smoking status and various war-related and sociodemographic variables.Methods: A community-based cross-sectional survey was conducted from March to April 2019 using an anonymous online questionnaire. The survey questionnaire solicited data on sociodemographic profile, medical history, smoking status and patterns along with some war-related impacts. Results: The sample comprised of 987 participants and had a mean age of 24.69 years. Around two-thirds of the overall cohort were females. Concerning smoking, a total of 371 participants (37.9%) were identified to be smokers, of whom 211, 84, 76 were exclusive shisha smokers, exclusive cigarette smokers, and dual smokers, respectively. Cigarette and shisha smoking was more common in males with p<0.0001. Males also smoked cigarettes and shisha daily, and in larger quantities than females p<0.05, while females were found to be more social smokers. Although cigarette smoking was more prevalent in older ages, shisha use was more prominent in younger ages. Losing someone close due to war was associated with smoking cigarettes p=0.002, and smoking in general p<0.001Conclusions: In our study, males tend to smoke more and be heavier smokers than females while females smoked shisha more frequently and socially. War and peer pressure were among the major contributors to smoking. Policies should aim to target young adults as shisha is becoming more popular among them.

Choice and variety-seeking of e-liquids and flavour categories by New Zealand smokers using an electronic cigarette: a longitudinal study

Background Little is currently known about how e-liquid flavour use evolves among electronic cigarette users. We describe patterns of e-liquid and flavour category use, and variety-seeking, among New Zealand adult smokers attempting to transition from smoking to e-cigarettes. Methods Data were collected in 2018–19, using a longitudinal design comprising up to five in-depth interviews over a 12–20 week period. Participants (n=32) were current smokers aged ≥ 18 years, who were not currently using an e-cigarette once a week or more often, and were willing to use an e-cigarette in an attempt to stop smoking. We purchased participants a starter e-cigarette of their choice; they supplied their own e-liquids throughout the study. We extracted e-liquid use data from the verbatim interview transcripts, categorised these into flavour categories, and then explored these data for the whole sample, and by flavour category purchased at intake. Results Most participants (n=12) selected a tobacco-flavoured e-liquid at intake; fruit (n=7), mint/menthol (n=6), and dessert/sweets and non-alcoholic beverage (both n=5) were also popular. Most participants were still using their initially chosen flavour category at study exit, however many described variety-seeking behaviours, which typically occurred during the first 12 weeks of enrolment. Conclusion Most participants did not follow a straightforward e-liquid or flavour category pathway. Evidence of a variety-seeking continuum, typically occurring within the first 12 weeks, suggests possible opportunities at specialist e-cigarette stores to couple e-liquid purchasing occasions with cessation advice. Implications Variety-seeking behaviour was common and typically reported within the first 12 weeks of participants’ e-cigarette-assisted attempt to transition away from smoking. Policies allowing diverse e-liquid flavours at specialist stores only could support users’ variety-seeking and potentially create opportunities to couple e-liquid purchasing occasions with cessation advice during the first months of a transition attempt.

Effect of usual source of care on receiving smoking cessation advice: Korean National Health Panel data analysis

Background Despite various anti-smoking policies, the smoking rate in adults is still high in Korea. Doctors’ advice is known to increase the smoking cessation success rate. However, few studies have reported the effect of having a usual source of care (USC) on receiving smoking cessation advice. Objective To determine the effect of USC on receiving smoking cessation advice. Methods We performed multiple panel logistic regression analyses to identify the effect of having a USC on the rate of receiving a doctor’s smoking cessation advice using 2009, 2012 and 2013 datasets from the Korea Health Panel database. Only people who responded to questions regarding a USC and smoking cessation advice were analysed. Eventually, 5243 observations were included in the final analysis. Results A higher percentage of people with a USC received smoking cessation advice from doctors (58.4% in 2009, 64.0% in 2012 and 59.6% in 2013) than those not having a USC (28.6% in 2009, 37.5% in 2012 and 34.8% in 2013). The odds ratios (ORs) of receiving smoking cessation advice in people with a USC were higher than those of people without a USC after performing multiple panel logistic regression analysis with random effects (OR: 2.24; 95% confidence interval: 1.90–2.63). Conclusions Having a USC increased the odds of receiving a doctor’s smoking cessation advice in Koreans. The results of this study suggest that a health care policy that encourages having a USC is useful in receiving more smoking cessation advice in a Korean population.