Although cigarette smoking during young adulthood is characterized by volatility, few studies examine if use of electronic nicotine delivery systems (ENDS) impacts transitions in cigarette use ...behaviors across this developmental period. The purpose of this longitudinal study was to examine the role of ENDS use on three transitions in cigarette smoking among young adults; initiation, desistance, and re-uptake. Methods: Participants were 5029 18–29-year-olds (64.2% female) enrolled in one of 24 Texas colleges at baseline and involved in an eight-wave, 4.5-year study. A multi-state, continuous time Markov model was used to assess the role of current/past 30-day and ever ENDS use on three transitions, spanning at least six months 1) never to current smoking (initiation); 2) current to non-current smoking (desistance); and 3) non-current to current smoking (re-uptake). The model also contained time-invariant socio-demographic, and time-varying intrapersonal (other tobacco use, nicotine dependence, sensation seeking, depressive symptoms) and interpersonal (peer cigarette use) covariates. Results: Both current and ever ENDS use increased the probability of transitioning from never to current cigarette use (initiation) and decreased the probability of transitioning from current to non-current use (desistance). Current, but not ever, ENDS use also increased the probability of transitioning from non-current to current use (re-uptake). Adjustment for socio-demographic, intrapersonal, and interpersonal covariates did not alter these findings. Discussion: ENDS use in young adulthood increases the risk for cigarette smoking behaviors across the continuum of uptake and progression. Prevention and cessation efforts targeting both ENDS and cigarette use during young adulthood are needed.
•There were numerous cigarette transitions, but stable never use was most prevalent.•The role of ENDS in cigarette use transitions across young adulthood is not known.•ENDS use elevated risk of smoking initiation and decreased probability of desistance.•ENDS use elevated risk for the re-uptake of smoking after a period of non-use.
This study examined patterns in mental health symptomatology and smoking and vaping behaviors among youth and young adults over a 1-year period from before to during the first year of the Coronavirus ...Disease 2019 (COVID-19) pandemic.
Participants (n = 2148) were 16-24-year-olds who completed three waves of the Texas Adolescent Tobacco and Marketing Surveillance Study (TATAMS). Descriptive statistics and mixed effects logistic regression models were used to examine changes in anxiety symptoms, depressive symptoms, perceived stress, and cigarette, e-cigarette, and marijuana use from before COVID-19 (fall 2019) to 6-month follow-up (spring 2020) and 12-month follow-up (fall 2020) periods during COVID-19. Longitudinal associations between mental health symptomatology and smoking and vaping were examined.
Modest increases in symptoms of anxiety and depression were observed from before to during COVID-19. Perceived stress remained high and unchanged. Ever marijuana use increased at 6- and 12-month follow-up, while ever cigarette and e-cigarette use increased significantly only at 12-month follow-up. Marijuana use frequency increased significantly at 6- and 12-month follow-ups. Adjusting for sociodemographic factors, increased symptoms of anxiety and depression predicted increases in ever cigarette, e-cigarette, and marijuana use, and past 30-day cigarette and e-cigarette use, but not past 30-day marijuana use. Higher perceived stress predicted increases in ever use of cigarettes and e-cigarettes and past 30-day cigarette use.
Changes in mental health symptomatology and smoking and vaping behaviors among young people in Texas varied during this period of the COVID era. Increases in mental health symptomatology predicted increases in cigarette, e-cigarette, and marijuana use behaviors.
This study adds to the limited research on the longitudinal impact of anxiety symptoms, depressive symptoms, and perceived stress on cigarette, e-cigarette, and marijuana use from before to during the first year of the COVID-19 pandemic. Findings warrant health messaging and interventions that address the significant impact of worse mental health on increased smoking and vaping behavior, especially during crises like COVID-19 that may exacerbate mental health and substance use behaviors.
Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is ...known about the age of initiation of cigar product use among youth.
Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12-17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and "fairly regular" use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data.
For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and "fairly regular" use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use.
Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.
To prospectively estimate the age of initiation of ever, past 30-day, and fairly regular hookah use among young adults (ages 18-24) overall, by sex, by race/ethnicity, and to explore the association ...of prior use of other tobacco products with these hookah use behaviors.
Secondary data analyses of the first four waves (2013-2017) of the PATH study, a nationally representative longitudinal cohort study of US young adults. Young adult never hookah users at the first wave of adult participation in PATH waves 1-3 (2013-2016) were followed-up into waves 2-4 (2014-2017) to estimate the age of initiation of three outcomes: (i) ever use, (ii) past 30-day use, and (iii) fairly regular hookah use. Weighted interval-censoring Cox proportional hazards regression models were used to examine the differences in the estimated age of initiation by sex and by race/ethnicity while controlling for the total number of other tobacco products ever used at participants' first wave of PATH participation. In addition, to examine if prior use of other tobacco products was associated with the age of hookah initiation behaviors, six additional Cox models are reported for each hookah initiation behaviors.
The largest increase in hookah use occurred between ages 18 and 19: 5.8% for ever use and 2.7% for past 30-day hookah use. By age 21, 10.5%, 4.7% and 1.2% reported initiation of ever, past 30-day and fairly regular hookah use, respectively. There were statistically significance differences in the age of initiation of hookah use behaviors by race/ethnicity.
Educational interventions should target young adults before the age of 21, focusing efforts specifically on males, non-Hispanic Blacks and Hispanics, to stall initiation and progression of hookah use behaviors.
We aimed to determine (1) the most commonly used brands of electronic vaping products (EVPs) by young adults in Texas during Spring 2023, and (2) if brand preferences differ by sociodemographic ...characteristics, current cigarette smoking, and current cannabis vaping.
Participants were 2,491 18-25-year-olds (Mean age = 20.6; 62.9% female; 29.7% sexual gender minority; 35.9% non-Hispanic White, 45.0% Hispanic/Latino, 3.5% non-Hispanic Black, 11.6% non-Hispanic Asian, and 4.0% two or more races or another race/ethnicity) enrolled in 21 Texas colleges during February-March 2023 who used EVPs in the past 30-days.
Esco Bar was the most popular EVP brand (32.5%), followed by Elf Bar (19%), Vuse (10.1%), and all other brands were used by < 10% of participants. Nearly 20% of participants reported not having a usual brand. Participants who used Esco Bar, Elf Bar, and Puff Bar were younger (i.e., 18-20 years old), female, and Hispanic/Latino. Vuse, JUUL, and Smok were used by participants who were older (i.e., 21-25 years old), male, non-Hispanic white, used EVPs daily, and currently smoked cigarettes.
The present study extends prior research by providing contemporary data on young adult EVP brand preferences in Texas during Spring 2023. Many of the brands commonly used by young adults (e.g., Esco Bar, Elf Bar) are not currently authorized for marketing or sale by the Food and Drug Administration. Findings underscore a need for additional enforcement efforts that prohibit the distribution and sale of these products to, in turn, prevent EVP use among young adults.
To examine the relationship between current cigarette smoking patterns and three established risk factors for suicide using nationally representative data of high school students in the United ...States.
We analyzed cross-sectional data from the national Youth Risk Behavior Surveillance Survey (YRBSS)-United States, 2017. Multivariable, logistic regressions examined the association between 3 cigarette smoking behaviors i.e., past 30-day cigarette (n = 13,731), frequent (n = 1,093) and heavy (n = 880) smoking and 3 risk factors for suicidal outcomes feeling sad or hopeless, suicidal ideation, suicide plan assessed over the previous year.
Among high school cigarette smokers, smoking 11 or more cigarettes per day (i.e., heavy smoking) was associated with 3.43 (95% CI: 1.69, 6.94) greater odds of reporting feeling sad or hopeless, 2.97 (95% CI: 1.60, 5.51) greater odds of reporting suicidal ideations, and 2.11 (95% CI: 1.34, 3.32) greater odds of reporting having ever planned a suicide attempt, controlling for covariates.
Our study shows that it is not simply cigarette smoking, but heavy cigarette smoking that is a risk factor for suicidal outcomes among adolescents.
A comprehensive plan is needed to accommodate heavy adolescent smokers who are at increased suicidal risk.
Background: As conventional cigarette use is declining, electronic cigarette ("e-cigarette") use is rising and is especially high among college students. Few studies examine dual use of e-cigarettes ...and cigarettes among this population. This study explores the relationship between dual and exclusive e-cigarette / cigarette use and perceptions of harm and addictiveness of both products. Methods: This is a cross-sectional analysis of data from students attending 24 colleges in Texas (n=5,482). Multinomial logistic regression was employed to test the association between current e-cigarette / cigarette use and perceived harm and addictiveness of both products. Three tobacco groups were included: cigarette only users, e-cigarette only users, and dual users. Results: Dual users reported lower perceived harm of e-cigarettes most consistently (p<0.001, all comparisons). Perceived harm of cigarettes was significantly lower among cigarette only and dual users only, compared to non-users (p<0.001, all comparisons). Compared to non-users, all three groups reported significantly lower perceived addictiveness of e-cigarettes (p<0.001, all comparisons). The same finding was observed for perceived addictiveness of cigarettes, though findings were less consistent for the e-cigarette only group (p<0.02, all comparisons except one). Conclusion: Findings demonstrate that among college students, perceptions of harm and addictiveness of e-cigarettes are lower than those for conventional cigarettes. For both products, perceptions of harm and addictiveness were lower among exclusive and dual users, compared to non-users.
•26.36 % of young adults who reported P30D use had used both tobacco and cannabis.•Poly co-users reported using e-cigarettes to quit cannabis more often than e-cigarette co-users.•Poly co-users used ...cannabis more for the taste than exclusive cannabis users.•Poly co-users used e-cigarettes because their friends do more often than dual tobacco users.
This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users.
Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use.
26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19–5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73–15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06–20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62–18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51–6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08–4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03–4.41) than exclusive cannabis users.
Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.
Historically, adolescence has been regarded as the time when most tobacco use initiation occurs. This study examines the initiation of tobacco product use, including cigarettes, e-cigarettes, cigar ...products, and hookah, among contemporary youth and young adults, to determine whether the developmental timing (youth vs. young adulthood) of initiation has changed.
Three cohort studies were used to examine the onset of ever use and current (past 30 days) use of each tobacco product among never-using youth (11 to <17 years) and young adults (18–24 years) at baseline (2013–2015) to one-year follow-up (2015–2016). These studies include the national Population Assessment of Tobacco and Health Study, and two Texas cohort studies, the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), and the Marketing and Promotions Across Colleges in Texas (M-PACT) project. Estimations of onset were computed using generalized linear mixed models for TATAMS and M-PACT. The rates of initiation in Population Assessment of Tobacco and Health Study were compared to standardized incidence rates from TATAMS to M-PACT.
Young adults had significantly higher incidence rates than youth to initiate ever and current use of each/all tobacco products for all comparisons.
These findings extend prior research on the timing of the onset of tobacco use by using longitudinal analyses from three contemporary cohort studies to include not just cigarettes, but also e-cigarettes, cigar products, and hookah. Among those who were never-users of tobacco products, young adults began to ever and currently use all tobacco products more than youth in these samples, a marked departure from prior decades of research.
Electronic nicotine delivery systems (ENDS) have become the most popular tobacco products among young people, yet ENDS marketing remains unregulated, and its effects on ENDS use behavior across age ...groups is poorly understood. In this study, using a longitudinal design, we examined how recall of ENDS marketing through 5 different channels predicted subsequent ENDS initiation up to 2.5 years later among youth (ages 12-17 years) and young adults (ages 18-29 years).
Data were drawn from 2 large cohort studies in Texas. The analysis included school-going youth (
= 2288) and college-going young adults (
= 2423) who reported never having used ENDS at baseline in 2014. Logistic regression was used to assess the influence of recalled ENDS marketing exposure via television (TV), radio or Internet radio, billboards, retail stores, and the Internet on subsequent ENDS initiation, with adjustment for these channels, baseline sociodemographics, other past-30-day tobacco use, sensation seeking, and peer ENDS use.
Recall of retail store-based ENDS marketing at baseline was associated with significantly higher odds of subsequent ENDS initiation among youth (adjusted odds ratio aOR = 1.99; 95% confidence interval CI: 1.25-3.17) and young adults (aOR = 1.30; 95% CI: 1.05-1.61) up to 2.5 years later. Young adult initiation was also associated with recalled ENDS marketing on TV at baseline (aOR = 1.29; 95% CI: 1.03-1.63).
Marketing of ENDS at retail stores predicts youth and young adult ENDS initiation, and marketing on TV predicts young adult initiation. Future research and regulation should be used to address the most influential marketing channels.
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