•Young adults are exposed to pro-tobacco messaging from both the industry and peers.•Exposure to tobacco marketing is associated with same-day product use.•Both user-generated and industry-sponsored ...messages are associated with tobacco use.
Tobacco-related content is prevalent on social media, yet many methods of measuring exposure are inadequate due to the personalized nature of online marketing. The purpose of this paper is to examine the association between exposure to pro-tobacco messages (both industry-sponsored and user-generated) and the use of tobacco products, as reported via ecological momentary assessment (EMA).
Young adults (n = 175) were instructed to record all sightings of marketing (both in-person and online) related to tobacco for 28 days. Tobacco product use and recall of message encounters were assessed daily using app-initiated EMA.
Participants who reported exposure to tobacco messages were significantly more likely to report using tobacco, adjusting for gender, age, race/ethnicity, baseline use of any tobacco product, and having friends who use tobacco and e-cigarettes (p <.001). For each industry-sponsored message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.77 (95 % CI = 1.41, 2.23). For each user-generated message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.52 (95 % CI = 1.27, 1.83).
To our knowledge, this is the first study to specifically examine the association between exposure to user-generated messages and daily tobacco use. The findings suggests that there is a unique element to user-generated messages that distinguishes them from both traditional marketing and from simple peer influence.
Highlights • Cigarettes and cigars had the highest rates of subjective experiences at first use. • Positive and neutral symptoms were associated with sustained cigarette and cigar. • Negative first ...use symptoms were associated with lower odds of current cigar use
•Estimation of the age of initiation of four hookah use outcomes among U.S. youth.•Female were at higher risk for susceptibility to hookah use at early ages.•Females were at higher risk of ever ...hookah use at early ages.•Hispanics were at higher risk for susceptibility to hookah use at early ages.•Hispanics were at higher risk of ever hookah use at early ages.
This study reports the prospectively estimated age of initiation of susceptibility to, ever, past 30-day, and fairly regular hookah use.
Secondary data analyses of the first four waves (2013–2017) of the PATH study, a nationally representative longitudinal cohort study of US youth (ages 12–17).
Youth who were never hookah users at their first wave of participation were identified (n = 16,678; N = 31,136,834). Four outcomes were analyzed, age of first report of: (i) susceptibility to use, (ii) ever use, (iii) past 30-day use, and (iv) fairly regular hookah use. The age of hookah initiation of each outcome was estimated. Weighted interval censoring survival analyses and Cox regression models were conducted to estimate the age of initiation of each hookah use outcome, and to estimate differences in age of initiation by sex and by race, respectively.
Around 11% of youth were classified as susceptible to hookah use by 13 years of age, 8% reported initiating ever hookah use by age 17, almost 10% reported initiating past 30-day hookah use by age 19, and 3% reported initiating fairly regular hookah use by age 20. Females and Hispanics were at higher risk of becoming susceptible to and ever hookah use at earlier ages compared to males and Non-Hispanic White youth.
Education, communication campaigns, and proven culturally targeted tobacco interventions that reach youth at ages before they first become susceptible or start using hookah use are needed to prevent the onset of hookah use among vulnerable youth.
•We assessed e-cigarette use behaviors among a nationally representative sample of Black/African American adults.•Compared to Black/African Americans who perceived e-cigarette use as less harmful ...than smoking cigarettes, those who perceived e-cigarette use as more harmful were less likely to use e-cigarettes daily.•Moderate or severe anxiety/depression symptoms were positively associated with current e-cigarette use.•Anxiety/depression moderated the association between perceived harmfulness of e-cigarette use and e-cigarette use.•E-cigarette use behaviors were sensitive to sociodemographic characteristics.
Black/African American adults are at greater risk of experiencing negative health outcomes stemming from tobacco use, yet little research has examined e-cigarette use behavior in the Black/African American adult-only population. We examined the association between e-cigarette use behaviors (never, former, and current use) and perceived harmfulness of e-cigarette use and anxiety/depression symptoms among Black/African American adults. This cross-sectional study was a secondary analysis of nationally representative data from the 2011–2020 Health Information National Trends Survey (n = 6,268). Multinomial logit models were used to examine differences in e-cigarette use behaviors (reference group = never used e-cigarettes), given the risk factors named above. The prevalence of former and current e-cigarette use among Blacks/African Americans was 11.65 % and 3.52 %, respectively. There was a significant interaction between the perceived harmfulness of e-cigarette use and anxiety/depression. Moderate or severe anxiety/depression symptoms were associated with a higher likelihood of current e-cigarette use, but not former e-cigarette use. Compared to individuals who perceived e-cigarette use as less harmful than smoking cigarettes, those who perceived e-cigarette use as just as harmful were less likely to be current e-cigarette users. Those who perceived e-cigarette use as more harmful or were uncertain were less likely to be former or current e-cigarette users. Anxiety/depression and perceived harmfulness of e-cigarette use and their interactions were significantly associated with e-cigarette use behaviors. These findings provide an opportunity to offer tobacco cessation and prevention interventions to subgroups in this population and inform development of content for the same.
Background
Studies show smoking and vaping behaviors increase risk of contracting and worse symptoms of COVID-19. This study examines whether past 30-day youth and young adult users of marijuana, ...e-cigarettes, and cigarettes self-reported changes in their use of these substances due to the COVID-19 pandemic; and cross-sectional associations between perceived stress, nicotine or marijuana dependence, and COVID-19–related changes in use.
Methods
Participants were 709 past 30-day self-reported substance users from the Texas Adolescent Tobacco and Marketing Surveillance study (TATAMS; mean age = 19; 58% female; 38% Hispanic, 35% white). Multiple logistic regression models assessed cross-sectional associations between perceived stress and dependence and increased, decreased, or sustained past 30-day use of marijuana, e-cigarettes, and cigarettes due to COVID-19 (e.g., “Has your marijuana use changed due to the COVID-19 outbreak?”). Covariates included age, race/ethnicity, socio-economic status (SES), dependence (exposure: stress), and stress (exposure: dependence).
Results
Most participants reported sustained (41%, 43%, 49%) or increased (37%, 34%, 25%) use of marijuana, e-cigarettes, and cigarettes due to COVID-19, respectively. Participants who reported symptoms of dependence were significantly more likely than their non-dependent peers to report increasing their marijuana (AOR: 1.66; 95% CI: 1.15–2.39) and e-cigarette (AOR: 2.57; 95% CI: 1.38–4.77) use. Those who reported higher perceived stress were significantly more likely to report increasing their marijuana use (AOR: 1.55; 95% CI: 1.01–2.42).
Conclusions
Most youth and young adults did not decrease their substance use amid a global, respiratory disease pandemic. Health messaging and interventions that address the health effects of smoking and vaping as well as factors like stress and dependence that may be barriers to decreasing use are vital in curbing the COVID-19 pandemic.
The objectives of this study were to 1) examine longitudinal predictors of JUUL and other tobacco product initiation, 2) compare these predictors across product type, and 3) describe cross-sectional ...characteristics of JUUL initiators, among a cohort of Texas adolescents. Analyses were also stratified to examine whether predictors of initiation differed by susceptibility to tobacco use at baseline. This study utilized data from Waves 7 and 8 (Fall 2017 and Spring 2018) of the Texas Adolescent Tobacco and Marketing Surveillance System (n = 2272). Chi-square tests and multinomial logistic regressions were conducted to examine differences in predictors of initiation. Among those who initiated at Wave 8 (n=107), 40.2% initiated JUUL, 43.9% initiated other ENDS, and 15.9% initiated other combustible tobacco. For the full sample, ever marijuana use predicted the initiation of all tobacco products (Relative Risk Ratios “RRRs” from 2.31–4.13) as compared to non-users. For non-susceptible youth, ever marijuana use significantly predicted the initiation of JUUL (RRR = 10.08, 95% CI = 2.11–48.17) and other ENDS use (RRR = 12.07, 95% CI = 2.97–49.04). Peer tobacco use predicted the initiation of JUUL (RRR = 3.06, 95% CI = 1.38–6.81) and other ENDS use (RRR = 5.36, 95% CI = 2.11–13.64) for the full sample, as well as those who were susceptible to tobacco use. For non-susceptible youth, peer tobacco use predicted the initiation of combustible tobacco use (RRR = 16.56, 95% CI = 1.56–175.84). Prominent reasons for JUUL use included curiosity, friend use, and less harmful that cigarettes. Results highlight the role of marijuana in the initiation of all tobacco products, even among low-risk youth; other predictors varied between product type. Interventions should address specific predictors to prevent youth from transitioning to tobacco use.
•Marijuana use predicted initiation of all tobacco products for the total sample.•For low risk youth, marijuana use predicted initiation of JUUL and other ENDS.•Recall of ENDS marketing was a significant predictor for JUUL initiation.•Peer tobacco use predicted initiation of combustible tobacco for low risk youth.•Reasons for JUUL use were curiosity, friend use, and less harmful than cigarettes.
Abstract
Introduction
While research has documented associations between recall of point-of-sale (POS) tobacco marketing and youth tobacco use, much of the research is cross-sectional and focused on ...cigarettes. The present longitudinal study examined recall of tobacco marketing at the POS and multiple types of tobacco use 6 months later.
Methods
The Texas Adolescent Tobacco Advertising and Marketing Surveillance System (TATAMS) is a large-scale, representative study of 6th, 8th, and 10th graders in 79 middle and high schools in five counties in Texas. Weighted logistic regression examined associations between recall of tobacco advertisements and products on display at baseline and ever use, current use, and susceptibility to use for cigarette, e-cigarette, cigar, and smokeless products 6 months later.
Results
Students’ recall of signs marketing e-cigarettes at baseline predicted ever e-cigarette use and increased susceptibility to use e-cigarettes at follow-up, across all store types. Recall of e-cigarette displays only predicted susceptibility to use e-cigarettes at follow-up, across all store types. Both recall of signs marketing cigars and cigar product displays predicted current and ever cigar smoking and increased susceptibility to smoking cigars at follow-up, across all store types. Recall of cigarette and smokeless product marketing and displays was not associated with tobacco use measures.
Conclusion
The POS environment continues to be an important influence on youth tobacco use. Restrictions on POS marketing, particularly around schools, are warranted.
Implications
Cross-sectional studies have shown that exposure to POS cigarette marketing is associated with use of cigarettes among youth, though longitudinal evidence of the same is sparse and mixed. Cross-sectional studies have found that recall of cigars, smokeless product, and e-cigarette tobacco marketing at POS is associated with curiosity about tobacco use or intentions to use tobacco among youth, but limited longitudinal research has been conducted. Findings from the present longitudinal study suggest that recall of tobacco marketing at retail POS predicts ever use of e-cigarettes and cigars, current use of cigars, and susceptibility to cigar and e-cigarette use among youth.
Multiple-tobacco product (MTP) use is common among adolescent tobacco users. Low positive affect is a risk factor for e-cigarette use and combustible tobacco smoking. In this study, we examine the ...longitudinal relationship between positive affect and MTP use in a diverse cohort of adolescents in Texas.
We analyzed 6 waves of biennial data (fall 2014-spring 2017) from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were 3868 sixth-, eighth-, and tenth-grade students in urban Texas, at enrollment. Multinomial logistic regression models examined the longitudinal relationship between positive affect and categories of MTP use, controlling for sex, race/ethnicity, past 30-day alcohol use, cohort, survey wave, and peer tobacco use.
The sample was comprised of 4.6% single-product users, 1.7% dual-users, and 0.7% poly-users. Each unit decrease in positive affect was associated with increased risk for single- (RRR: 1.29; 95% CI: 1.16-1.44), dual- (RRR: 1.35; 95% CI: 1.11-1.64), and poly- (RRR: 1.98; 95% CI: 1.54-2.54) use, relative to non-use. Similarly, each unit decrease in positive affect was also associated with increased risk for poly-tobacco use relative to single- (RRR: 1.53; 95% CI: 1.19-1.97) and dual- (RRR: 1.47; 95% CI: 1.11-1.95) use. Positive affect did not differentiate between single- and dual-use.
We observed a gradient relationship between low positive affect and greater number of tobacco products used. Findings reinforce the association between poor mental health and tobacco use during adolescence. Prevention efforts may need to incorporate methods of addressing low positive affect.
•More than half of marijuana vapers in this study increased use during COVID-19.•Participants noted that COVID-19 led to more negative attitudes about vaping.•Changes in attitudes about vaping did ...not translate into reductions in vaping use.•Boredom was a common theme for increasing vaping.
Research is lacking on the impact of the COVID-19 pandemic on marijuana vaping behaviors; a notable limitation as marijuana vaping has been previously associated with respiratory issues among young people. This qualitative study explored how the COVID-19 pandemic influenced vaping perceptions and behaviors among young adults (18 to 25-year-olds).
Qualitative interviews were conducted with 50 regular marijuana vapers. Individuals were eligible if they vaped marijuana at least 3 days per week (exclusively or dual use with nicotine). Interview transcripts were analyzed using deductive coding processes to identify themes. Differences in themes by gender and user status (regular marijuana versus regular dual vapers) were explored.
While many participants indicated that the pandemic negatively impacted their attitudes about vaping, participants also noted that their negative attitudes did not translate into reductions in use. Overall, 54% of participants reported increasing vaping during COVID-19. For both regular dual vapers and marijuana vapers, boredom was a prominent theme for increases in vaping. Lack of accessibility of marijuana was cited as a reason for decreasing marijuana among regular marijuana vapers but not for regular dual vapers. Males reported more unchanged attitudes about vaping and more males than females reported still sharing their devices.
More than half of participants reported increasing their vaping behaviors since the COVID-19 pandemic despite concerns about the potential for vaping to adversely impact lung and immune health. As the U.S. adapts to the COVID-19 pandemic, interventions should address factors that may contribute to increases in use behaviors.
The association of use of electronic nicotine delivery systems (ENDS) with the age of asthma onset is unknown.
To explore the association of past 30-day ENDS use with the age of asthma onset in ...adults and youths who did not have asthma or chronic obstructive pulmonary disease and never used cigarettes.
This cohort study was a secondary analysis of waves 1 to 6 of the US nationally representative Population of Tobacco and Health Study (2013-2021). Eligible participants included adults (≥18 years) and youths (12-17 years) who did not have asthma or chronic obstructive pulmonary disease at the first wave of participation. Data analysis was conducted from September 2022 to April 2024.
Past 30-day ENDS use at the first wave of participation in the study preceding the onset of asthma.
Lower and upper age limits were estimated using the age reported at the first wave of participation and the number of weeks between follow-up waves until asthma was first reported or censored. The association of past 30-day ENDS use with the age of asthma onset was estimated using weighted interval-censoring Cox regression. The cumulative hazard function for the age of asthma onset was estimated using interval-censoring survival analysis.
A total of 24 789 participants were included, with 7766 adults (4461 female weighted percentage, 59.11% and 3305 male weighted percentage, 40.89%), representing 80.0 million adults, and 17 023 youths (8514 female weighted percentage, 50.60% and 8496 male weighted percentage 49.32%), representing 33.9 million youths. By age 27 years, 6.2 per 1000 adults reported asthma incidence (hazard ratio HR, 0.62%; 95% CI, 0.46%-0.75%). While controlling for covariates, there was a 252% increased risk of the onset of asthma at earlier ages for adults who used ENDS in the past 30 days vs adults who did not (adjusted HR, 3.52; 95% CI, 1.24-10.02). For youths, there was no association of ENDS use in the past 30 days with age of asthma onset (adjusted HR, 1.79; 95% CI, 0.67-4.77), which could be due to a lack of statistical power.
In this cohort study, past 30-day ENDS use among adults was associated with earlier ages of asthma onset. These findings suggest that prevention and cessation programs directed to adults who use ENDS are needed to educate the public, protect public health, prevent adverse health outcomes, and motivate users to stop. Furthermore, modifying symptom-screening asthma guidelines, resulting in earlier asthma detection and treatment, may reduce morbidity and mortality due to asthma.
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