Abstract
Introduction
Despite increases in e-cigarette sales restrictions, support for sales restrictions and perceived impact on young adult use are unclear.
Aims and Methods
We analyzed ...February-May 2020 data from a longitudinal study of 2159 young adults (ages 18–34; Mage = 24.75 ± 4.71; n = 550 past 30-day e-cigarette users) in six metropolitan areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, and Seattle). We examined support for e-cigarette sales restrictions and—among e-cigarette users—perceived impact of flavored vape product and all vape product sales restrictions on e-cigarette and cigarette use (and potential correlates; ie, e-cigarette/tobacco use, use-related symptoms/health concerns).
Results
About 24.2% of e-cigarette users (and 57.6% of nonusers) supported (strongly/somewhat) sales restrictions on flavored vape products; 15.1% of e-cigarette users (45.1% of nonusers) supported complete vape product sales restrictions. If restricted to tobacco flavors, 39.1% of e-cigarette users reported being likely (very/somewhat) to continue using e-cigarettes (30.5% not at all likely); 33.2% were likely to switch to cigarettes (45.5% not at all). Considering complete vape product sales restrictions, equal numbers (~39%) were likely versus not at all likely to switch to cigarettes. Greater policy support correlated with being e-cigarette nonusers (adjusted R2 aR2 = .210); among users, correlates included fewer days of use and greater symptoms and health concerns (aR2 = .393). If such restrictions were implemented, those less likely to report continuing to vape or switching to cigarettes used e-cigarettes on fewer days, were never smokers, and indicated greater health concern (aR2 = .361).
Conclusions
While lower-risk users may be more positively impacted by such policies, other young adult user subgroups may not experience benefit.
Implications
Young adult e-cigarette users indicate low support for e-cigarette sales restrictions (both for flavored products and complete restrictions). Moreover, if vape product sales were restricted to tobacco flavors, 39.1% of users reported being likely to continue using e-cigarettes but 33.2% were likely to switch to cigarettes. If vape product sales were entirely restricted, e-cigarette users were equally likely to switch to cigarettes versus not (~40%). Those most likely to report positive impact of such policies being implemented were less frequent users, never smokers, and those with greater e-cigarette-related health concerns. This research should be considered in future tobacco control initiatives.
Given increases in youth cannabis and alcohol use and changes in the cannabis market, we examined parental openness and communication about cannabis and alcohol.
Among 197 participants who had ...children ≤18 years old and lived in six US metropolitan areas (Atlanta, Boston, Minneapolis, Oklahoma City, San Diego, Seattle), we examined sociodemographic and use correlates of parental openness (i.e., acceptability of child use, rules regarding use in the home or around children, communication) about cannabis and alcohol, as well as being more open about cannabis versus alcohol.
In this sample (M
= 32.30, 70.1% female, 30.5% sexual minority, 33.0% racial/ethnic minority, 41.6% in recreational cannabis state), 33.5% reported past-month cannabis use, and 59.9% alcohol (22.8% used both, 29.4% used neither). Multivariable regression indicated that cannabis users (vs. nonusers) and sexual minority (vs. heterosexual) individuals were more open about cannabis use; alcohol users (vs. nonusers) were more open about alcohol use. Additionally, older parental and child age correlated with greater cannabis- and alcohol-related communication, and females (vs. males) reported greater cannabis-related communication. Those married/cohabitating and reporting past-month alcohol use were less likely to allow cannabis versus alcohol in the home or near children. Parents in legalized recreational (vs. nonlegalized) states, females, and heterosexual individuals reported greater cannabis- versus alcohol-related communication.
Interventions are needed to support parental communication regarding substance use, particularly cannabis.
This study addressed parenting and youth substance use during evolving cannabis legislation and can inform youth substance use prevention interventions targeting parent-child communication.
Highlights • Surveyed 18–34 year old past month marijuana users living in the U.S. (N = 742). • Over half of participants were exposed to marijuana advertising in the past month. • Advertisements ...were commonly viewed on digital media (i.e. online, social media). • Exposure to marijuana advertising was associated with heavier, more potent use.
Given ongoing gaps in adherence to Pap testing recommendations, this study examined: 1) adherence to Pap test screening recommendations; and 2) barriers to Pap test screening among those who were ...nonadherent, using constructs from the Andersen model. We analyzed Spring 2022 survey data among 541 US young adults who reported having a cervix (
n
= 541; mean age = 27.73, 42.1% heterosexual, 57.9% sexual minority, 86.0% woman, 3.7% transgender man, 68.2% White, 31.8% racial/ethnic minority). Multivariable logistic regression examined sociodemographic correlates of nonadherence to Pap testing recommendations (i.e., no Pap testing in the past 3 years). Among those who were nonadherent, barriers to Pap testing were assessed. 68.6% (
n
= 371) were defined as adherent and 31.4% (
n
= 170) nonadherent. Multivariable regression findings indicated significant differences by race/ethnicity such that Asians (vs. Whites) were more likely to be nonadherent (OR = 2.41, CI = 1.11, 3.70,
p
= .021); no other differences in relation to race/ethnicity or sexual/gender identity were found. The most commonly reported barriers were: “I have not gotten around to it” (42.9%), “getting a Pap test is just not a priority for me” (30.6%), “fear/worry” (28.2%), “dislike/don’t like having procedures done” (27.1%), “my healthcare provider has never mentioned it” (21.2%), “haven’t had sex so I don’t consider myself at high risk” (20.6%), and “COVID-19 pandemic prevented me” (15.3%). Pap testing is underutilized among young adults in the US, particularly Asians. Multilevel interventions must address barriers within the healthcare system (e.g., provider recommendation), external environment (e.g., societal factors), and individual realm (e.g., perceptions).
Abstract Limited research has examined polysubstance use profiles among young adults focusing on the various tobacco products currently available. We examined use patterns of various tobacco ...products, marijuana, and alcohol using data from the baseline survey of a multiwave longitudinal study of 3418 students aged 18–25 recruited from seven U.S. college campuses. We assessed sociodemographics, individual-level factors (depression; perceptions of harm and addictiveness,), and sociocontextual factors (parental/friend use). We conducted a latent class analysis and multivariable logistic regression to examine correlates of class membership (Abstainers were referent group). Results indicated five classes: Abstainers (26.1% per past 4-month use), Alcohol only users (38.9%), Heavy polytobacco users (7.3%), Light polytobacco users (17.3%), and little cigar and cigarillo (LCC)/hookah/marijuana co-users (10.4%). The most stable was LCC/hookah/marijuana co-users (77.3% classified as such in past 30-day and 4-month timeframes), followed by Heavy polytobacco users (53.2% classified consistently). Relative to Abstainers, Heavy polytobacco users were less likely to be Black and have no friends using alcohol and perceived harm of tobacco and marijuana use lower. Light polytobacco users were older, more likely to have parents using tobacco, and less likely to have friends using tobacco. LCC/hookah/marijuana co-users were older and more likely to have parents using tobacco. Alcohol only users perceived tobacco and marijuana use to be less socially acceptable, were more likely to have parents using alcohol and friends using marijuana, but less likely to have friends using tobacco. These findings may inform substance use prevention and recovery programs by better characterizing polysubstance use patterns.
We examined correlates of low engagement in the healthcare system, experiences with survivorship care, barriers to follow-up care, and potential resources for promoting follow-up care among young ...adult survivors of childhood cancers. We conducted a mixed-method study involving surveys of 106 survivors of childhood cancer aged 18–34 recruited from a university-affiliated children’s hospital and an NCI-designated cancer center in the Southeastern USA. Phone-based semistructured interviews were then conducted in a subset of 26. Assessments included health factors, psychosocial factors, healthcare system interaction, and interest in resources to promote engagement in healthcare. Survey participants were on average 22.14 (SD = 3.16) years old, 50.0 % female, and 77.4 % White. Overall, 46.0 % had attended survivorship clinic, 47.2 % reported receiving a treatment summary, 68.9 % had a primary care provider, and 17.0 % reported no interaction with healthcare in the past 2 years. Correlates of less than annual healthcare provider visits included being older (
p
= 0.003), being male (
p
< 0.001), lack of insurance (
p
= 0.002), and having had chemotherapy (
p
= 0.05). Participants reported varied experiences in terms of how health and treatment information was presented, from none or too little to overwhelming or anxiety-provoking amounts. Barriers to engaging in survivorship care included no/limited insurance, time, or transportation; major life changes; anxiety; and difficulty transitioning from pediatrics to adult care. Participants highlighted the need for educational and psychosocial resources, particularly technology-based resources. Multilevel interventions are needed to increase engagement in survivorship care among young adult cancer survivors. Technology-based resources addressing social support and mental well-being are intervention possibilities.
IntroductionGiven that the US Food and Drug Administration (FDA) authorised reduced exposure messaging to be used in IQOS marketing, we examined: (1) IQOS ad content; (2) advertising media channels ...and (3) changes in advertising efforts over time.MethodsWe conducted a mixed-methods study regarding IQOS ad content (headlines, themes, images), ad occurrence characteristics (including content, media channels and adspend) in the USA from August 2019 to April 2021 using Numerator advertising/marketing data.ResultsAcross 24 unique ads and 591 occurrences (84.6% online, 8.0% print, 7.4% mobile), there was $4 902 110 total adspend (98.9% allocated to print). Across unique ads, occurrences and adspend, prominent themes included ‘real tobacco’ (45.8%, 47.4%, 30.1%, respectively), less odour/ash (29.2%, 21.0%, 29.9%) and switching from cigarettes (25.0%, 19.5%, 69.4%), and images mainly featured the product alone (58.2%, 61.4%, 99.5%) or with women (25.0%, 19.1%, 0.3%). Per occurrences and adspend, the most prominent media channel themes (eg, magazine/website topics) were technology (19.3%, 10.6%), women’s fashion (18.1%, 26.2%), weather/news (9.0%, 15.3%) and entertainment/pop culture/gaming (8.5%, 23.1%). Ad themes appearing only post-FDA authorisation included switching from traditional cigarettes, same-day/home-delivery, convenience (eg, use indoors), reduced exposure to some dangerous substances, science/research and distinction from e-cigarettes. Overall adspend per occurrence increased postauthorisation (p=0.016); the highest adspend per unique ad (69.3% of total) focused on ads featuring reduced exposure.ConclusionsRegulatory efforts must be informed by ongoing surveillance of IQOS marketing efforts and its impacts, particularly how specific consumer subgroups (eg, tobacco non-users, women, young people) are impacted by marketing exposure.
Correspondence to Dr Yael Bar-Zeev, Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel; yael.bar-zeev@mail.huji.ac.il ...New progressive tobacco control legislation in Israel restricted advertising of all tobacco and related products, including heated tobacco products and electronic cigarettes. The three main elements comprised: (1) advertising bans in all media, including broadcast, outdoor, internet and print media, but excluding newspapers (effective March 2019); (2) bans on point-of-sale displays except in specialised tobacco and alcohol outlets (effective January 2020); and (3) plain packaging (effective January 2020).1–3 During the initial implementation phase, an active tobacco control coalition communicated via social media (‘WhatsApp’) regarding tobacco industry tactics to bypass legislative efforts, test the limits of the legislation and/or test the government’s ability to enforce the legislation. ...highlighting that plain packaging did not change the product (‘different packaging, same product’) or using original colours and names adjacent to plain packaging in advertisements to highlight the differences between the different brands. (figure 1C) Specify exactly the additional wording and colours allowed to be used in any advertisement, with reference to plain packaging. *Internet sales of products are only allowed to include the name of the product, country of manufacturer, price, parts and components of the product and their amount, and regarding electronic cigarettes—also the nicotine concentration in the product. †It is not completely clear whether these new signs are considered a violation of the new law. The proposed bill was a private bill, not initiated by the government. ...including a comprehensive enforcement plan, which would have required allocating significant funding and personnel, may have resulted in lack of governmental support for the bill, and further delay in the approval of the bill.
IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal ...tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI's advertising messages changed during these regulatory periods for both IQOS and cigarettes.
Content analysis of PMI's IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ
test or Fisher's exact test.
The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p<0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p<0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging.
IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance.
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