Electronic cigarettes (e-cigarettes) are available in nontraditional flavors (eg, fruit and candy) that are banned in combustible cigarettes in the United States. Whether adolescent use of ...e-cigarettes in nontraditional flavors prospectively predicts continuation of vaping and progression to more frequent vaping is unknown.
High school students in Los Angeles, California, completed 5 semiannual surveys (2014-2017 10th grade to 12th grade). Among past-6-month e-cigarette users at survey waves 1 to 4 (
= 478), e-cigarette flavor (or flavors) used was coded into 2 mutually exclusive categories at each wave (use of ≥1 nontraditional flavors fruit, candy, sweet or dessert, buttery, blends or combinations, and other versus exclusive use of tobacco, menthol or mint, or flavorless). Flavor used during waves 1 to 4 was modeled as a time-varying, time-lagged regressor of vaping status and frequency outcomes 6 months later at waves 2 to 5.
Across waves 1 to 4, there were 739 (93.8%) observations of nontraditional-flavor use and 49 (6.2%) observations of exclusive use of tobacco, mint or menthol, or flavorless e-cigarettes. Use of e-cigarettes in nontraditional flavors (versus only tobacco, mint or menthol, or flavorless) was positively associated with vaping continuation (64.3% vs 42.9%; adjusted odds ratio = 3.76 95% confidence interval 1.20 to 10.31) and past-30-day number of puffs per nicotine vaping episode (mean: 3.1 SD 5.5 vs 1.5 SD 3.8; adjusted rate ratio = 2.41 95% confidence interval 1.08 to 5.92) 6 months later. Flavor used was not associated with the subsequent number of past-30-day vaping days or episodes per day.
Adolescents who vaped e-cigarettes in nontraditional flavors, compared with those who exclusively vaped tobacco-flavored, mint- or menthol-flavored, or flavorless e-cigarettes, were more likely to continue vaping and take more puffs per vaping occasion 6 months later.
Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco.
To evaluate whether e-cigarette use ...among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah).
Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections.
Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline.
Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3).
Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% 95% CI, 16.4%-28.9%) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% 95% CI, 10.0%-21.8%). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio OR, 4.27 95% CI, 3.19-5.71) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 95% CI, 2.00-3.73). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 95% CI, 1.73-4.05), cigar (OR, 4.85 95% CI, 3.38-6.96), and hookah (OR, 3.25 95% CI, 2.29-4.62) use and with the number of different combustible products used (OR, 4.26 95% CI, 3.16-5.74) averaged across the 2 follow-up periods.
Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.
MDMA (± 3,4-methylenedioxymethamphetamine, 'ecstasy') is used recreationally, reportedly because it increases feelings of empathy, sociability, and interpersonal closeness. One line of evidence ...suggests that MDMA produces these effects by releasing oxytocin, a peptide involved in social bonding. In the current study, we investigated the acute effects of MDMA and oxytocin on social and emotional processing in healthy human volunteers. MDMA users (N = 65) participated in a 4-session, within-between-subjects study in which they received oral MDMA (0.75, 1.5 mg/kg), intranasal oxytocin (20 or 40 IU), or placebo under double-blind conditions. The primary outcomes included measures of emotion recognition and sociability (desire to be with others). Cardiovascular and subjective effects were also assessed. As expected, MDMA dose-dependently increased heart rate and blood pressure and feelings of euphoria (eg, 'High' and 'Like Drug'). On measures of social function, MDMA impaired recognition of angry and fearful facial expressions, and the larger dose (1.5 mg/kg) increased desire to be with others, compared with placebo. Oxytocin produced small but significant increases in feelings of sociability and enhanced recognition of sad facial expressions. Additionally, responses to oxytocin were related to responses to MDMA with subjects on two subjective measures of sociability. Thus, MDMA increased euphoria and feelings of sociability, perhaps by reducing sensitivity to subtle signs of negative emotions in others. The present findings provide only limited support for the idea that oxytocin produces the prosocial effects of MDMA.
e-Cigarette companies use cartoon images to market their products, and exposure to this marketing strategy may lead to increased risk for adolescent e-cigarette use. This study examined the effects ...of cartoon marketing image exposure on perceived expectations of benefits and risks of e-cigarette use, and willingness to buy e-cigarette-related products in the future, among adolescents with and without a history of e-cigarette use. To accomplish this, participants completed an online survey experiment, during which they were randomly assigned to view pictures of e-cigarette products with cartoon or noncartoon packaging, followed by questionnaires about wanting to buy e-cigarettes, and perceived benefits and risks of e-cigarette use. Participants, a sample of Southern California high school students (ninth to 11th grade; N = 1,376), completed the study from September 2021 to November 2021. Overall, 27% of participants had used an e-cigarette or other tobacco product at least once in their lifetime (ever user). Thirty-six percent of participants never used e-cigarettes or other tobacco products but were considered to be susceptible to using e-cigarettes in the future (susceptible-never user). Thirty-seven percent of participants never used e-cigarettes or other tobacco products and were considered insusceptible to using e-cigarettes in the future (insusceptible-never user). There were no significant differences between image exposure groups (cartoon, no cartoon) on demographic variables (age, gender, race/ethnicity), lifetime e-cigarette use, or susceptibility to use in the future. Exposure to e-cigarette-related cartoon-based marketing produced lower perceived e-cigarette-related risks in insusceptible-never users. Exposure to e-cigarette marketing with cartoon images decreases the perceived harmfulness of e-cigarettes, which can increase adolescents' intentions to try e-cigarettes. Curbing adolescent e-cigarette use is a national public health priority.
Public Health Significance
This study indicates that exposure to cartoon images on e-cigarette-related packaging decreases the perceived harmfulness of the use of e-cigarettes among adolescents. This could increase adolescents' intentions to try e-cigarettes in the future, thus potentially increasing the tobacco burden.
•Recent research has shown that e-cigarette companies use cartoon-based marketing strategies.•Adolescents are exposed to e-cigarette-related cartoon marketing and these adolescents are using ...e-cigarettes.•Restrictions on cartoon-based marketing of e-cigarettes should be considered to prevent further exposure.
Recent research has shown that e-cigarette companies use cartoon-based marketing. Recognition of this cartoon-based marketing has been associated with increased risk for e-cigarette use in young adults, however it is unclear if this generalizes to adolescents. This study examined the associations between recognition of e-liquid packaging with cartoons and e-cigarette use, susceptibility to use, and expectations of benefits and risks of use in adolescents.
A cross-sectional sample of adolescents drawn from three Southern California high schools (n = 1,734; 55% female; Mean SD age = 15.20.9) completed online surveys assessing e-cigarette use, susceptibility to use, expectations about benefits and risks of use, and tobacco marketing exposure. To assess recognition of cartoon images, participants were presented with 40 images of e-liquid packages (20 with and 20 without cartoons) and asked to endorse whether they recognized the products. The primary predictor was relative cartoon recognition (i.e., percentage of cartoons recognized out of the total images recognized).
Relative recognition of cartoon images was positively associated with e-cigarette use, susceptibility to use, and a perceived social benefit of use.
Adolescents recognize e-cigarette-related cartoon marketing, and these adolescents are using e-cigarettes. The restriction of cartoon-based marketing of e-cigarettes may affect e-cigarette uptake among adolescents.
Highlights • Urinary oxytocin levels increase after MDMA and intranasal oxytocin administration. • In healthy adults urine and plasma oxytocin levels are correlated after taking MDMA. • In ASD youths ...urine and plasma oxytocin levels are correlated after taking oxytocin.
The US Food and Drug Administration (FDA) recently restricted characterizing flavors in tobacco products. As a result, ice hybrid-flavored e-cigarettes, which combine a cooling flavor with fruit or ...other flavors (eg, banana ice), emerged on the market. Like menthol, ice-flavored e-cigarettes produce a cooling sensory experience. It is unclear if ice hybrid-flavored e-cigarettes should be considered characterizing flavors or menthol, limiting regulatory action. Monitoring the public's conversations about ice-flavored e-cigarettes on Twitter may help inform the tobacco control community about these products and contribute to the US FDA policy targets in the future.
This study documented the themes pertaining to vaping and ice flavor-related conversations on Twitter. Our goal was to identify key conversation trends and ascertain users' recent experiences with ice-flavored e-cigarette products.
Posts containing vaping-related (eg, "vape," "ecig," "e-juice," or "e-cigarette") and ice-related (ie, "Ice," "Cool," "Frost," and "Arctic") terms were collected from Twitter's streaming application programming interface from January 1 to July 21, 2021. After removing retweets, a random sample of posts (N=2001) was selected, with 590 posts included in the content analysis. Themes were developed through an inductive approach. Theme co-occurrence was also examined.
Many of the 590 posts were marked as (or consisted of) marketing material (n=306, 51.9%), contained positive personal testimonials (n=180, 30.5%), and mentioned disposable pods (n=117, 19.8%). Other themes had relatively low prevalence in the sample: neutral personal testimonials (n=45, 7.6%), cannabidiol products (n=41, 7%), negative personal testimonials (n=41, 7%), "official" flavor description (n=37, 6.3%), ice-flavored JUUL (n=19, 3.2%), information seeking (n=14, 2.4%), and comparison to combustible tobacco (n=10, 1.7%). The most common co-occurring themes in a single tweet were related to marketing and disposable pods (n=73, 12.4%).
Our findings offer insight into the public's experience with and understanding of ice-flavored e-cigarette products. Ice-flavored e-cigarette products are actively marketed on Twitter, and the messages about them are positive. Public health education campaigns on the harms of flavored e-cigarettes may help to reduce positive social norms about ice-flavored products. Future studies should evaluate the relationship between exposure to personal testimonials of ice-flavored vaping products and curiosity, harm perceptions, and experimentation with these products among priority populations.
Summary MDMA (±3,4-methylenedioxymethamphetamine, ‘ecstasy’) is reportedly used recreationally because it increases feelings of sociability and interpersonal closeness. Prior work suggests that the ...pro-social effects of MDMA may be mediated by release of oxytocin. A direct examination of plasma levels of oxytocin after acute doses of oxytocin and MDMA, in the same individuals, would provide further evidence for the idea that MDMA produces its pro-social effects by increasing oxytocin. Fourteen healthy MDMA users participated in a 4-session, double-blind study in which they received oral MDMA (0.75 and 1.5 mg/kg), intranasal oxytocin (20 IU or 40 IU), and placebo. Plasma oxytocin concentrations, as well as cardiovascular and subjective effects were assessed before and at several time points after drug administration. MDMA (1.5 mg/kg only) increased plasma oxytocin levels to a mean peak of 83.7 pg/ml at approximately 90–120 min, compared to 18.6 pg/ml after placebo. Intranasal oxytocin (40 IU, but not 20 IU) increased plasma oxytocin levels to 48.0 pg/ml, 30–60 min after nasal spray administration. MDMA dose-dependently increased heart rate, blood pressure, feelings of euphoria (e.g., ‘High’ and ‘Like Drug’), and feelings of sociability, whereas oxytocin had no cardiovascular or subjective effects. The subjective and cardiovascular responses to MDMA were not related to plasma oxytocin levels, although the N was small for this analysis. Future studies examining the effects of oxytocin antagonists on responses to MDMA will help to determine the mechanism by which MDMA produces pro-social effects.
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