To examine and compare trends in past 30-day cigarette smoking among adolescents in the US from 2002 to 2019, before and after the onset of the “e-cigarette era” in 2014. Using National Youth Tobacco ...Survey (NYTS) data from 2002 to 2019, we modeled the prevalence of past 30-day cigarette smoking over time. A total of n = 274,551 (weighted N = 340,403,754) middle and high school students were included in this study. Interrupted time series analyses were used to examine changes in cigarette smoking over time and compare trends in cigarette smoking pre- and post-2014. Models were applied to the full sample and stratified by middle (6th–8th grade) and high school (9th–12th grade). The observed number of current adolescent cigarette smokers post-2014 was compared to the predicted number, given trends in cigarette smoking prevalence observed pre-2014. Among all students, past 30-day cigarette smoking declined by approximately 0.75% per year from 2002 to 2013 (p < 0.001). Following a significant drop in prevalence from 2013 to 2014 (1.64%; p < 0.001), the decline in past 30-day cigarette smoking slowed significantly to approximately 0.37% per year (p < 0.001), from 2015 to 2019. We estimate that the onset of the “e-cigarette era” in 2014 corresponded to over 1.66 million (95% CI: 1.57 m – 1.75 m) more past 30-day cigarette smokers from 2015 to 2019, cumulatively. The rate of decline in past 30-day cigarette smoking prevalence among adolescents observed since 2002 slowed with the onset of the “e-cigarette era” in 2014, providing evidence at a population-level for the “gateway effect.”
•The “e-cigarette era” began in 2014, with the rise in use among youth.•Youth cigarette smoking declined 0.75% per year prior to the “e-cigarette era” (2002−2013)•Youth cigarette smoking declined 0.37% per year during the “e-cigarette era” (2014–2019).•The “e-cigarette era” increased the number of youth smokers by 1.66 million from 2014 to 2019.
•Time to first cravings did not differ by internalizing symptoms among young people.•Time to first really needing to use did not differ by internalizing symptoms.•Time to first use within 30 min did ...not differ by internalizing symptoms.
To determine the relationship between past-year internalizing symptoms and the time to first report of signs of nicotine dependence among young people.
Secondary analysis using data from the Population Assessment of Tobacco and Health (PATH) (Waves 1–5; 2013–2019). The study included 2,102 (N = 5,031,691) young people (age 12–23 years) who reported past-30-day (P30D) e-cigarette use in one or more waves. Kaplan Meier curves, stratified by past year internalizing symptoms were used to estimate the time to the first report of three nicotine dependence symptoms (i.e., use within 30 min of waking, cravings, and really needing to use) following the first P30D e-cigarette use. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios (AHR), comparing any past year internalizing symptoms to no past year internalizing symptoms.
We found no significant differences between past year internalizing symptoms and the time to the first report of cravings (AHR = 1.30, 95 % CI = 92–1.85), really needing to use (AHR = 1.31; 95 % CI = 0.92–1.89) and use within 30 min of waking for follow-up times 0–156 weeks (AHR = 0.84; 95 % CI = 0.55–1.30) and > 156 weeks (AHR = 0.41; 95 % CI = 0.04–4.67) respectively.
Past year internalizing symptoms did not modify the time to the first report of nicotine dependence among youth with P30D e-cigarette use. Further research is needed to understand how changing internalizing symptoms and e-cigarette use frequency influence nicotine dependence over time and, how this relationship impacts cessation behavior.
•Approximately 1 in 5 never blunt smokers initiated during the transition from youth to young adulthood.•More than half (56.8%) of current blunt smokers continued using at each follow-up ...observation.•Risk for blunt initiation was greater among Hispanic (72%) and NH-Black (115%), relative to NH-White.•Alcohol use was common predictor of transitioning from never to current blunt use each race/ethnic category.
To characterize and compare transitions in blunt smoking behaviors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021.
We analyzed n = 14,152 observations (i.e., completed surveys) provided by n = 2,610 youth and young adults over six (6) waves from Spring 2019 to Fall 2021 via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were recruited in age-cohorts, reflecting 16.5 years (0.5), 18.5 years (0.6), and 20.1 years (0.8) of age at baseline. We applied a three-state Markov model to estimate blunt initiation (never → ever), onset (never → current), continuation (ever → current), and discontinuation (current → ever). First, we compared transitions in blunt smoking by race/ethnicity, with non-Hispanic (NH) Whites as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of blunt transitions, including sex, age, alcohol use, depression, anxiety, and tobacco cigar smoking.
At baseline, 73% of participants had never smoked blunts, 15.3% had ever smoked blunts s, and 11.7% currently smoked blunts. NHB (HR: 2.15; 95% CI: 1.21–3.84) and Hispanic (HR: 1.72; 95% CI: 1.08–2.72) participants had significantly greater risk of blunt smoking initiation, relative to NHWs. Similarly, NHBs had great risk for continuation (HR: 1.65; 95% CI: 1.16–2.34) and lower risk of discontinuation (HR: 0.57; 95% CI: 0.42–0.77), relative to NHWs. Alcohol use predicted greater risk for onset among NHW (HR: 5.22; 95% CI: 1.40–19.45), NHB (HR: 3.14; 95% CI: 1.32–7.46), and Hispanic (HR: 2.99; 95% CI: 1.80–4.97) participants.
Blunt smoking initiation was most common among NHB and Hispanic youth and young adults while risk for sustained blunt smoking was higher in NHB youth and young adults. Research and interventions should investigate the link between alcohol use and elevated blunt smoking among young people.
No studies of young adults have compared symptoms of nicotine dependence among exclusive past 30-day (P30D) ENDS users versus exclusive P30D cigarette smokers.
Participants at Wave 14 (Fall 2021) of ...The Texas Adolescent and Tobacco Marketing Surveillance System (TATAMS) (n = 2,341; mean age = 20.95 years old) who reported P30D exclusive ENDS use (n = 212) and P30D exclusive cigarette smoking (n = 46). Symptoms of nicotine dependence were measured with the Hooked On Nicotine Checklist (the 10-item HONC scale). An independent samples t-test compared average HONC scores between groups, and a Pearson (or Fisher's Exact) Chi-Square (X2) test compared the prevalence of symptom(s) between groups.
The average HONC score was significantly higher for exclusive P30D ENDS users than exclusive P30D cigarette smokers (3.51 vs. 1.91, p ≤ 0.001). Compared to exclusive P30D cigarette smokers, a significantly higher proportion of exclusive P30D ENDS users reported having felt addicted (45.28% vs. 15.22%, p ≤ 0.001), having strong cravings (50.00% vs. 28.26%, p = 0.007), difficulty not using in prohibited places (i.e., school or work) (24.06% vs. 4.35%, p = 0.002), difficulty concentrating (21.23% vs. 6.52%, p = 0.021), and feeling nervous, restless, or anxious (28.77% vs. 10.87%, p = 0.012).
Symptoms of nicotine dependence were elevated among young adults who were exclusive P30D users of ENDS relative to exclusive P30D cigarette smokers.
This study examines smoke-free youth partnerships implementing the Teens Against Tobacco Use model developed by the American Lung Association. This innovative tobacco prevention strategy has not been ...evaluated rigorously. Students used peer teaching to educate youth about tobacco use and engaged in tobacco control advocacy activities. Participating high school and middle school youth were trained to develop and deliver tobacco prevention presentations to 4th–8th grade students in schools.
To evaluate the efficacy of the presentations, matched pairs of classrooms willing to have 1 presentation were randomly assigned to receive either the presentation first (intervention condition) or later in the school year (control condition).
The study took place in a predominantly low-income Hispanic community. A total of 9 schools, 107 classes, and 2,257 students participated in the evaluation.
Tobacco susceptibility was assessed with a brief survey administered to students in both intervention and control classrooms in 2014 and 2015 after the completion of presentations in intervention classrooms. Analyses completed in 2019 compared intervention and control classrooms on tobacco susceptibility.
Intent-to-treat analyses indicated that classrooms receiving a tobacco prevention presentation had significantly lower tobacco susceptibility scores than classrooms that did not receive a presentation (12% vs 17%, p<0.01), representing a 37% reduction in the odds of tobacco susceptibility. Teens Against Tobacco Use presenters also completed tobacco retailer compliance checks and gained media coverage in advocating to regulate e-cigarettes in the same manner as other tobacco products.
Findings suggest Teens Against Tobacco Use is an effective means of reducing tobacco susceptibility among 4th–8th graders in the immediate term. Longer-term outcome evaluations are needed to determine whether Teens Against Tobacco Use presentations can have a lasting impact on tobacco use.
This study is registered at www.clinicaltrials.gov NCT02443025.
Previous research has established an association between internalizing and externalizing problems with e-cigarette use in youth. Secondary analysis of Population Assessment of Tobacco and Health ...youth waves 1–4(2013–2017). Age of initiation of ever e-cigarette use and age of first report of past 30-day e-cigarette use were prospectively estimated among never e-cigarette users(waves 1–3). Weighted interval-censoring multivariable Cox proportional hazard models were fit to assess differences in each e-cigarette outcome among youth with internalizing and externalizing problems, as well as the interaction between internalizing and externalizing problems, while adjusting for covariates. Weighted interval-censoring survival analyses estimated the age of initiation of ever and age of first report of past 30-day e-cigarette use stratified by internalizing and externalizing problems. Among youth never e-cigarette users, those with high internalizing problems and high externalizing problems had increased risk of initiating ever e-cigarette use at earlier ages compared to youth with none/low internalizing and externalizing problems, respectively. Youth with high internalizing problems and high externalizing problems had increased risk of first reporting past 30-day e-cigarette use at earlier ages compared to youth with none/low internalizing problems, respectively. By age 17, 36.3% of youth with high internalizing problems and 38.5% of youth with high externalizing problems initiated ever e-cigarette use. By age 17, 16.8% of youth with high internalizing and 18.7% of youth with high externalizing problems first reported past 30-day e-cigarette use. Youth with internalizing and externalizing problems should be screened for e-cigarette use and provided with proper resources to prevent onset of e-cigarette use.
•Internalizing problems increase the risk of earlier ages of e-cigarette initiation.•Externalizing problems increase the risk of earlier ages of e-cigarette initiation.•Prevention efforts should assess youth for mental health issues and e-cigarette use.
E-cigarettes are the most commonly used tobacco product among youth and young adults in the US. Limited research has examined how stress impacts e-cigarette use among young people. We examine the ...longitudinal associations between perceived stress scale (PSS) score and e-cigarette use behaviors among a diverse cohort of emerging adults. We analyzed two waves of data collected in Fall 2019 (baseline) and Spring 2020 (6-month follow-up) of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were classified into three mutually exclusive subsamples at baseline: (1) n = 1177 never e-cigarette users; (2) n = 806 ever but not current (past 30-day) e-cigarette users (i.e., ever users); and (3) n = 257 current (past 30-day) e-cigarette users. Three multivariate logistic regression models examined the relationship between PSS at baseline and: (1) initiation among never users; (2) progression to current use among ever users; and (3) continuation among current users, at 6-month follow-up. PSS scores were standardized using z-scores. Models controlled for race/ethnicity, sex, age, ever marijuana use, and ever use of other tobacco products. Mean age ranged from 18.6 to 19.4 among cohorts. Risk for e-cigarette progression among ever users (aOR: 1.30; 95%CI: 1.01–1.69) and e-cigarette continuation among current users (aOR: 1.33 (95%CI: 1.01–1.75) increased with each unit increase in PSS score at baseline. PSS at baseline was not associated with e-cigarette initiation among never users. PSS predicted greater risk of e-cigarette progression and continuation but not initiation among a diverse cohort of emerging adults. E-cigarette prevention and cessation strategies should consider perceived stress an important risk factor for e-cigarette use during emerging adulthood.
Our original paper is: Harrell MB, Mantey DS, Baojiang C, Kelder SH, Barrington-Trimis J. Impact of the e-cigarette era on cigarette smoking among youth in the United States A population-level study. ...Preventive Medicine 2022; 164:107265). This is a response to correspondence received from Foxon and Juul Labs Inc. (JUUL) regarding our original paper.
Use of electronic nicotine delivery systems (ENDS) increased significantly after 2017. The increase is attributed to a surge in popularity of vape pods containing nicotine salts, which are high ...nicotine concentration ENDS that may heighten risk for dependence. However, little is known about changes in ENDS dependence before and after the 2017 surge. We examined the trajectory of ENDS dependence among young adults from 2014 to 2019.
Participants were 1700 18-25-year-olds (57.6 % female) from 24 Texas colleges who reported past 30-day ENDS use in at least one of eight study waves. ENDS dependence was assessed at all waves with one item, use of ENDS within 30 min of waking. A discontinuous growth curve model was fit to test the hypothesis that the ENDS dependence trajectory would increase only after 2017, from 2018 to 2019. The model included socio-demographic and cigarette dependence covariates RESULTS: The proportion of young adults reporting ENDS dependence ranged from 2.3 % in 2014 to 8.2 % in 2019. Results from the discontinuous growth curve model indicated that the ENDS dependence trajectory was flat from fall 2014 to spring 2017. However, the post-2017 trajectory, from spring 2018 to spring 2019, was positive and significant indicating that the proportion of young adults reporting ENDS dependence increased after 2017.
The increase in ENDS dependence after 2017 likely resulted from the surge in popularity of vape pods containing nicotine salts. These vape pods are a disruptive technology that may result in more young adults developing nicotine dependence symptoms than do earlier generation devices.
Introduction
E‐cigarette, or vaping, product use‐associated lung injury (EVALI) results from inhaling the aerosol of e‐cigarettes and has similar clinical features to coronavirus disease 2019 ...(COVID‐19). EVALI case counts since the declaration of the COVID‐19 pandemic is unknown.
Methods
A retrospective electronic health record chart review of adolescents hospitalized at one institution with EVALI was conducted. Clinical characteristics and hospital course of patients hospitalized during the pandemic were compared to those prepandemic.
Results
The clinical presentation of adolescents hospitalized prior‐to (n = 19) and during the COVID‐19 pandemic (n = 22) were similar with respect to constitutional, respiratory, and gastrointestinal symptoms. All patients hospitalized during the pandemic were tested for COVID‐19 at least once. Only one patient had a positive SARS‐CoV‐2 RT‐PCR test result. Thirty‐one out of 39 patients treated with corticosteroids had clinical improvement within 24 h (79%). Patients hospitalized during the pandemic had a shorter median length of stay (5 vs. 7 days, p < 0.01), and were less often discharged with home oxygen (1 vs. 6 patients, p = 0.04). Pulmonary function tests improved pre‐ to postcorticosteroid treatment and postcorticosteroid to follow‐up.
Conclusions
Eliciting a history of vaping in adolescents presenting with constitutional, respiratory, and gastrointestinal symptoms is important to identify EVALI cases, which have continued throughout the COVID‐19 pandemic. A shorter length of stay with less need for mechanical ventilation and home oxygen in adolescents hospitalized during the pandemic may reflect increased familiarity with EVALI characteristics. Corticosteroids led to clinical and pulmonary function improvement.
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