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  • 1
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    Online Resource
    Racial/Ethnic Differences in Associations of Non-cigarette Tobacco Product Use With Subsequent Initiation of Cigarettes in US Youths
    Oxford University Press (OUP) ; 2021
    In:  Nicotine & Tobacco Research Vol. 23, No. 6 ( 2021-05-24), p. 900-908
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 23, No. 6 ( 2021-05-24), p. 900-908
    Abstract: Understanding which non-cigarette 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 non-cigarette 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 (odds ratio [OR], 2.76; 95% confidence interval [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 non-cigarette 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 non-cigarette 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 versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntaa170
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 2
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    Critical Challenges and Creative Solutions for Quantifying Nicotine Vaping: Qualitative Reports From Young Adults
    Oxford University Press (OUP) ; 2022
    In:  Nicotine & Tobacco Research Vol. 24, No. 3 ( 2022-02-14), p. 416-420
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 24, No. 3 ( 2022-02-14), p. 416-420
    Abstract: Previous studies suggest that young adults who vape nicotine experience difficulty when answering survey items assessing the quantity of vaping. The current study asked young adults who vape to provide suggestions for improving the scientific measurement of vaping. Aims and Methods We conducted semi-structured qualitative interviews with 62 young adults who vape in Los Angeles, California between June 2018 and June 2019. We analyzed participants' responses to the following question: “What do you think is the best way for us to understand how much people vape?” using thematic content analysis. Results We identified two major themes: (1) challenges stemming from differences between the way researchers query about vaping and how individuals self-monitor vaping frequency, and (2) insights for future measurement of vaping. Participants reported that challenges of accurately quantifying vaping were due to inherently hard-to-answer questions (eg, puffs per day), lack of awareness of or not actively monitoring consumption of vaping products, or because vaping behaviors vary considerably between and within individuals over time, making “on-average” questions challenging. Participants discussed ideas for improving survey measures that could accurately assess vaping quantity, including querying about the type of device used, and frequency of replenishment of nicotine solutions. Conclusions Existing vaping behavior survey measures may not accurately capture the quantity of vaping as they differ from how (or if) participants track their own vaping consumption patterns. While continued research is needed to optimally refine survey measures on vaping consumption, future measures may better align with vapers' self-monitoring by including questions on device-type and replenishment frequency. Implications The present study provides insights regarding the variability that exists between vaping quantity measurements utilized by researchers and individuals who consume e-cigarettes. The qualitative data analyzed for this study support previous reports of difficulties faced by vapers when asked questions by researchers related to their vaping behavior. Furthermore, the present findings suggest the direction for the future development of accurate measurements of vaping frequency.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntab074
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 3
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    Differentiating Reasons for Young Adult E-cigarette Use Using Maximum Difference Choice Models
    Oxford University Press (OUP) ; 2023
    In:  Nicotine and Tobacco Research Vol. 25, No. 6 ( 2023-05-22), p. 1116-1124
    Details
    In: Nicotine and Tobacco Research, Oxford University Press (OUP), Vol. 25, No. 6 ( 2023-05-22), p. 1116-1124
    Abstract: Understanding the reasons young adults use e-cigarettes (ie, vape)—and whether these motivations vary across groups—is essential for informing tobacco regulatory efforts. Aims and Methods An online panel of young adults who vape (n = 230; age = 18–30 years) completed a maximum difference discrete choice task for 15 reasons for vaping. Over 9 choice sets, participants were presented a subset of 5 reasons and selected the most and least important. Hierarchical bayesian analysis estimated the relative importance of each reason. Latent class analysis (LCA) identified groups with similarly ranked reasons for use. Multinomial regression evaluated the association between sample characteristics and class membership. Results Overall, relaxation had the highest probability of being the most important reason for use (14.8%), followed by harm reduction (13.2%), and flavors (10.3%). LCA identified five distinct classes, based on top reasons for use: 1. cessation (cigarette cessation [20.2%]; n = 80); 2. dependence (relaxation [20.5%] and unable to quit [19.2%]; n = 21); 3. relaxation (relaxation [20.6%] ; n = 66); 4. socializing (socializing [22.2%]; n = 27); and 5. variable (boredom [10.5%] and acceptability [10.2%]; n = 36). Participants who were older, smoked cigarettes, or vaped more frequently were more likely to belong to the cessation class while those who were younger or more e-cigarette dependent were more likely to belong to the dependence class. Conclusions Perceived reasons why young adults vape are highly heterogeneous and dependent on the type of user. Tobacco regulatory efforts targeting distinct types of vapers are needed to minimize the adverse public health impact of vaping without compromising appeal for smoking cessation. Implications E-cigarette use remains high among young adults, with flavors, cost, and harm reduction (vs. combustible cigarettes) among the mostly commonly reported reasons for use. Yet, little is known about how relatively important these reasons are to the individual. Leveraging a maximum difference task, young adults’ reasons for use were evaluated on a common interval scale and groups sharing similar reasons identified. Smoking cessation, dependence, relaxation, socialization, and boredom were respectively the most important reasons for use among five classes of vapers. E-cigarette regulatory policies should consider the distinct reasons for use as to not compromise their appeal for smoking cessation.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntad017
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 4
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    Prevalence of Young Adult Vaping, Substance Vaped, and Purchase Location Across Five Categories of Vaping Devices
    Oxford University Press (OUP) ; 2021
    In:  Nicotine & Tobacco Research Vol. 23, No. 5 ( 2021-05-04), p. 829-835
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 23, No. 5 ( 2021-05-04), p. 829-835
    Abstract: The rapidly evolving landscape of vaping devices has complicated analyses of use patterns among youth and young adults. The current study describes the prevalence of use, substances vaped, and purchasing behaviors across five different vaping device categories. Aims and Methods Participants (n = 2505; mean age = 19.2, SD = 0.46) from a cohort in the Los Angeles area completed web-based surveys from June 2018 to October 2019. For each of four device type categories depicted via digital images (any pod-style vape, cigalike, box-mod, vape pen) and for JUUL specifically, participants reported ever and past 30-day use, substance vaped (mostly nicotine, nicotine and tetrahydrocannabinol [THC], mostly THC, neither), ownership of device (yes/no), where they obtained that device (eg, purchased themselves, from a friend), and if purchased, purchase location (eg, vape shop, online). Results Overall, 44.9% reported ever use, and 26.2% reported past 30-day use of at least one of the devices. The prevalence of past 30-day use was highest for pod-style vapes (any pod = 17.0%; JUUL = 15.1%). Among respondents who reported ever owning any device (n = 643 [25.7%]), 59.9% reported purchasing the device themselves, despite not being of legal purchasing age (15.4% of total sample); across all device types, products were most often purchased in vape shops or online. Conclusions Across all devices, the prevalence of self-purchase of vaping devices among underage young adults in the Los Angeles area was high, and most were purchased from a vape shop or online. Tobacco control policies to prevent underage purchase of tobacco products—particularly among never smokers—are needed. Implications A high proportion of underage young adults reported owning their own vaping device and having purchased it themselves from a vape shop or online. Stronger tobacco control policies and better enforcement efforts are needed to successfully prevent underage purchase of tobacco products.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntaa232
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 5
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    Accessing Vaping Products When Underage: A Qualitative Study of Young Adults in Southern California
    Oxford University Press (OUP) ; 2021
    In:  Nicotine & Tobacco Research Vol. 23, No. 5 ( 2021-05-04), p. 836-841
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 23, No. 5 ( 2021-05-04), p. 836-841
    Abstract: California implemented multiple strategies, such as a Tobacco 21 law and compliance checks, to reduce high rates of youth e-cigarette use. However, the prevalence of use among underage youth and young adults continues rising. Little is known about how underage individuals obtain e-cigarettes. Aims and Methods We conducted structured qualitative interviews with 61 young adult (18–25 years old) vapers in the Los Angeles, CA area between June 2018 and June 2019. Interviews were comprehensive and designed to elicit information on participants’ thoughts, feelings, and experiences related to vaping. We queried participants on where and how they obtained vaping products, and participants discussed their experiences accessing products while under the legal age for sale. Directed content analysis was used to analyze interviews. Results Four concepts emerged: (1) early experimentation of e-cigarettes with peers often occurred in a school setting, (2) continued use of e-cigarettes commonly obtained through peer sales, (3) inconsistent implementation of age restrictions at in-person retailers, and (4) at online retailers. Participants had peers purchase products on their behalf and frequented in-person and online retailers with few to no age verification processes. Few participants faced challenges when purchasing products from retailers. Conclusions The current study’s findings offer insight into where and how underage individuals obtain vaping products despite restrictions to prevent them from doing so. Participant accounts of mixed ease of underage purchasing in-person and online suggest retailer education is needed, along with additional research to inform more effective policies to reduce underage access to vaping products. Implications Despite legal age restrictions, e-cigarettes remain accessible to underage individuals, but specific strategies that underage youth utilize to evade legal age restrictions are largely unknown. We found that participants often accessed vaping products for the first time at school. Sales between peers were common, and participants also reported frequenting in-person retailers that inconsistently enforced age restrictions. Many participants reported little to no age verification online, though some believed online age verification measures were increasingly difficult to surpass. Knowledge of strategies underage youth utilize to access e-cigarettes can inform enforcement efforts.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntaa221
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 6
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    Trajectories of Nicotine Use Leading to Dual and Cyclical Tobacco Product Use in Young Adults
    Oxford University Press (OUP) ; 2022
    In:  Nicotine & Tobacco Research Vol. 24, No. 7 ( 2022-06-15), p. 986-993
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 24, No. 7 ( 2022-06-15), p. 986-993
    Abstract: Young adult never-smokers who vape are at elevated risk of initiating cigarettes, while young adults who smoke often begin vaping to substitute or reduce cigarette use. Reasons underlying different use patterns of tobacco products are not well-understood. Aims and Methods We conducted 1-on-1 qualitative interviews with young adults (N = 62) who vape in Los Angeles, California from June 2018 to June 2019. Participants were 18–25 years old (79% male; racially/ethnically diverse) and self-reported vaping ≥1x/week. We used a semi-structured interview guide and applied thematic analysis method to analyze data. Results Young adults initiated vaping due to peer socialization and e-liquid flavor novelty. They often reported vaping (after first smoking) due to a belief that e-cigarettes are healthier, social pressure to quit smoking, and convenience of use. Participants reported smoking (after first vaping) when traveling outside of the United States where vaping products were less accessible, and cigarettes were normative. Many of the personal narratives described patterns of dual and cyclical use, which was often attributed to nicotine dependence and cost, or described as dependent upon the current environment (eg, at a party). Conclusions The current study characterizes nicotine use trajectories and reasons why young adults vape, and smoke cigarettes. Dual and cyclical use of both e-cigarettes and cigarettes was common; this pattern of use should be considered in policy and prevention work to address nicotine dependence among young people. Implications We display findings from the current study in a model depicting common trajectories of nicotine use, along with reasons for initiation, transitions between products, and dual/cyclical e-cigarette and combustible cigarette use.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntab249
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 7
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    Characterizing Polytobacco Use Trajectories and Their Associations With Substance Use and Mental Health Across Mid-Adolescence
    Oxford University Press (OUP) ; 2018
    In:  Nicotine & Tobacco Research Vol. 20, No. suppl_1 ( 2018-08-14), p. S31-S38
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 20, No. suppl_1 ( 2018-08-14), p. S31-S38
    Type of Medium: Online Resource
    ISSN: 1462-2203 , 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntx270
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 8
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    Hookah Use Among US Youth: A Systematic Review of the Literature From 2009 to 2017
    Oxford University Press (OUP) ; 2019
    In:  Nicotine & Tobacco Research Vol. 21, No. 12 ( 2019-11-19), p. 1590-1599
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 21, No. 12 ( 2019-11-19), p. 1590-1599
    Abstract: Given the US Food and Drug Administration (FDA)’s authority to regulate hookah, more research is needed to inform regulations intended to prevent youth from using hookah. This systematic review summarizes and assesses the literature related to hookah use among adolescents (11 to ≤18 years of age) in the United States from 2009 to 2017. Methods Database searches yielded 867 peer-reviewed articles. After duplicates were removed, authors reviewed 461 articles for inclusion. Included articles (n = 55) were coded for study themes, study quality, and their relevance to FDA’s research priorities. A qualitative synthesis is presented. Results The following themes were identified: (1) prevalence of hookah use (n = 42), (2) tobacco use transitions (n = 7), (3) sociodemographic correlates (n = 35), (4) psychosocial risk factors (n = 21), (5) concurrent use of other tobacco products (n = 31), (6) concurrent use of other substances (n = 9), and (7) other (n = 15)—which includes low prevalence themes. The qualitative synthesis showed increasing rates of hookah use. Older age, male gender, positive social normative beliefs, higher peer use, as well as lower perceived risk were associated with hookah use. Longitudinal studies of youth hookah use showed bidirectional relationships between use of hookah and other tobacco products. All articles fell within FDA’s research priority related to “behavior,” and three priorities (“impact analysis,” “health effects,” and “toxicity”) have not been explored for hookah use among US youth since 2009. Conclusions The prevalence of hookah use among youth in the United States is increasing, thus more research is needed to inform policies targeted to protect this vulnerable population. Implications This study represents a novel contribution to our understanding of hookah use among youth in the United States from 2009—the year that the Family Smoking Prevention and Tobacco Control Act was passed—to 2017. In recent years, hookah has become a more popular tobacco product among US youth; however, to date, no systematic reviews of hookah use among this population exist. Results highlight implications for future US FDA regulatory policy and identify gaps in research to be addressed in future studies.
    Type of Medium: Online Resource
    ISSN: 1462-2203 , 1469-994X
    URL: Article
    DOI: 10.1093/ntr/nty135
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 9
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    Building a Foundation for Evidence-Based Decision-Making on E-Cigarettes
    Oxford University Press (OUP) ; 2022
    In:  Nicotine & Tobacco Research Vol. 24, No. 3 ( 2022-02-14), p. 293-294
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 24, No. 3 ( 2022-02-14), p. 293-294
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntab254
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 10
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    First E-Cigarette Flavor and Device Type Used: Associations With Vaping Persistence, Frequency, and Dependence in Young Adults
    Oxford University Press (OUP) ; 2022
    In:  Nicotine & Tobacco Research Vol. 24, No. 3 ( 2022-02-14), p. 380-387
    Details
    In: Nicotine & Tobacco Research, Oxford University Press (OUP), Vol. 24, No. 3 ( 2022-02-14), p. 380-387
    Abstract: Type of e-cigarette flavoring and device during first use might differentiate later e-cigarette use and dependence. This retrospective cross-sectional study examined associations of recalled first nicotine vaping device and flavor used with current vaping frequency/dependence. Aims and Methods A young adult cohort from Los Angeles, California, USA completed web-based surveys (N = 2553). Using cross-sectional data from 971 reporting ever vaping nicotine, multivariable hurdle regressions tested associations between recalled first flavor (fruit/sweet, menthol/mint, other) and device (Juul, disposable, mod, box, pod, pen, other) vaped with past-30-day vaping status (yes/no) and frequency (1–30 days), and with any vaping dependence symptoms (yes/no) and count (1–10 symptoms). Results The most common first-flavor was sweet (71%); the most common first-device was a vape pen (37%), then Juul (22%). First-flavor of mint/menthol (vs. other; adjusted odds ratio [AOR]: 2.22[95% CI = 1.16 to 4.25] ), and first-device mod (AOR = 2.40[95% CI = 1.34 to 4.31]) and non-Juul pod (2.64[95% CI = 1.41 to 4.92] ) (vs. pen) were associated with past-30-day vaping, and twice as many vaping days (adjusted rate ratios [ARRs] range: 1.96–2.12; ps & lt; .05). First flavor of mint/menthol (vs. other; AOR: 1.95[95% CI = 1.003 to 3.79) and first device mod, box, non-Juul pod, and other (AORs range: 2.36–4.01; ps & lt; .05) were associated with nicotine dependence. First device Juul, mod, box, and non-Juul pod were also associated with more dependence symptoms (ARRs range:1.38–1.59; ps & lt; .05). Conclusions Exposure to mint/menthol and certain devices (mod, box, Juul, and non-Juul pods) at first e-cigarette use may be associated with more frequent e-cigarette use and nicotine dependence symptoms in young adulthood. Mint/menthol and certain devices warrant consideration in regulation of e-cigarettes based on product characteristics. Implications Characteristics (flavor and device type) of first e-cigarette product used were associated with higher usage and more dependence. Pending replication with prospective designs, the findings suggest certain flavors (mint/menthol) and devices (pods, mods) merit consideration in regulation because of their possible link with continued use and dependence among young people.
    Type of Medium: Online Resource
    ISSN: 1469-994X
    URL: Article
    DOI: 10.1093/ntr/ntab172
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2020202-7
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