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Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Adolescents".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 52234

Special Issue Editors

Dr. Mary Hrywna

E-Mail Website
Leading Guest Editor
Rutgers Center for Tobacco Studies & Rutgers School of Public Health
Interests: tobacco control policy; tobacco regulatory science; population health; priority/special populations; surveillance and monitoring; non-cigarette tobacco products
Dr. Ollie Ganz

E-Mail Website
Assistant Guest Editor
Rutgers Center for Tobacco Studies & Rutgers School of Public Health
Interests: tobacco control; health communication; health disparities; tobacco regulatory science; mental health; LGBT health
Dr. Adam Cole

E-Mail Website
Assistant Guest Editor
Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street NorthOshawa, ON, L1G 0C5, Canada
Interests: public health; substance use; child and adolescent health; school/campus health promotion; chronic disease prevention; program and policy evaluation

Special Issue Information

Dear Colleagues,

Although youth cigarette use had declined steadily in the U.S., use of emerging tobacco products, particularly e-cigarettes, has increased substantially in the last few years. Surpassing cigarettes in 2014, e-cigarettes are now the most commonly used tobacco product among youths and young adults. This changing tobacco product landscape is further complicated by the diversity of tobacco use patterns in adolescent users, including nondaily use, lower intensity use, use of multiple tobacco products, and flavored tobacco product use. Furthermore, tobacco use remains disproportionately high among certain populations. This Special Issue welcomes studies that examine interventions and policies, in the U.S. and globally, designed to prevent tobacco use, delay initiation, reduce harm, and/or increase cessation among older children or adolescents (ages 12–18) or young adults (18-24). We encourage a variety of work including but not limited to systematic reviews, mixed methods studies, and secondary data analysis, with an emphasis on tobacco-related disparities in vulnerable adolescent populations.

Dr. Mary Hrywna
Dr. Ollie Ganz
Dr. Adam Cole
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Youth
  • Adolescents
  • Smoking
  • Tobacco use
  • Children
  • Smoking cessation
  • Electronic cigarettes
  • Tobacco prevention
  • Tobacco regulatory science

Published Papers (19 papers)

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13 pages, 724 KiB  
Article
Youth Assets, Neighborhood Factors, Parental Income, and Tobacco Use: A Longitudinal Study of Health Disparities
by Eleni L. Tolma, Sara K. Vesely, Lindsay Boeckman, Roy F. Oman and Cheryl B. Aspy
Int. J. Environ. Res. Public Health 2022, 19(19), 12330; https://doi.org/10.3390/ijerph191912330 - 28 Sep 2022
Viewed by 1021
Abstract
This study aimed to assess how the relationship between youth assets and future no-tobacco use among youth might differ according to race/ethnicity, neighborhood factors and socio-economic status. Five waves of annual data were collected from 1111 youth/parent pairs living in Oklahoma, USA who [...] Read more.
This study aimed to assess how the relationship between youth assets and future no-tobacco use among youth might differ according to race/ethnicity, neighborhood factors and socio-economic status. Five waves of annual data were collected from 1111 youth/parent pairs living in Oklahoma, USA who were randomly selected to participate in the Youth Asset Study (YAS). A marginal logistic regression model using all five waves of no-tobacco use, demographics, and their interaction was used to compare the change in tobacco use over time. Among 1111 youth, (Mean age = 14.3; 53% female; 39% White, 28% Hispanic, 24% Black, and 9% other), the percentage of youth tobacco use increased significantly from baseline to wave 5 (4 years after baseline) for all racial/ethnic groups and all parental income groups. Assets were prospectively associated with no tobacco use in the past 30 days for Black, White and Hispanic youth and for youth in all income categories (adjusted odds ratio range = 1.9–2.7). There was one statistically significant association between the neighborhood environment and future no tobacco use. To conclude, the protective effects of youth assets in terms of prevention of tobacco use among youth do not differ by youth race/ethnicity or parental income in the presence of neighborhood environmental factors. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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8 pages, 589 KiB  
Article
A Pilot Feasibility Study of an Online Youth Tobacco Survey Administration among High School Students
by Kaitlyn M. Mazzilli, Michelle T. Bover Manderski, Cristine D. Delnevo and Mary Hrywna
Int. J. Environ. Res. Public Health 2022, 19(16), 9911; https://doi.org/10.3390/ijerph19169911 - 11 Aug 2022
Cited by 1 | Viewed by 1297
Abstract
The COVID-19 pandemic restrictions forced many schools to shift to remote or hybrid learning, disrupting surveillance systems such as the New Jersey Youth Tobacco Survey, traditionally administered in schools by paper and pencil. In spring 2021, we conducted a feasibility study among a [...] Read more.
The COVID-19 pandemic restrictions forced many schools to shift to remote or hybrid learning, disrupting surveillance systems such as the New Jersey Youth Tobacco Survey, traditionally administered in schools by paper and pencil. In spring 2021, we conducted a feasibility study among a convenience sample of six public high schools to assess the use of an online survey to allow for remote participation. In each school, 4 to 6 classes were selected randomly, and all students within a sampled class were selected to participate in the survey. A total of 702 students completed surveys. School contacts were asked to provide qualitative feedback about the survey administration. Feedback was generally positive, with a few suggestions for improvement. Approximately 19% of students reported the ever use of e-cigarettes. Among current e-cigarette users, there was a shift in popularity from prefilled or refillable pods or cartridges (23.3%) to disposable e-cigarettes (53.5%). Less than 10% of current e-cigarette users reported using tobacco-flavored e-cigarettes, despite a statewide flavor ban on all other flavors. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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15 pages, 375 KiB  
Article
Adolescents, Young Adults, and Adults Continue to Use E-Cigarette Devices and Flavors Two Years after FDA Discretionary Enforcement
by Devin M. McCauley, Shivani Mathur Gaiha, Lauren Kass Lempert and Bonnie Halpern-Felsher
Int. J. Environ. Res. Public Health 2022, 19(14), 8747; https://doi.org/10.3390/ijerph19148747 - 18 Jul 2022
Cited by 13 | Viewed by 2399
Abstract
This study assesses the use of e-cigarette devices and flavors using a large, cross-sectional survey of adolescents, young adults, and adults (N = 6131; ages 13–40 years old; Mage = 21.9) conducted from November to December 2021, 22 months after the FDA [...] Read more.
This study assesses the use of e-cigarette devices and flavors using a large, cross-sectional survey of adolescents, young adults, and adults (N = 6131; ages 13–40 years old; Mage = 21.9) conducted from November to December 2021, 22 months after the FDA announced its prioritized enforcement policy against some flavored pod/cartridge-based e-cigarettes. We analyzed the patterns of use by age group: adolescents and young adults (AYAs) under 21 (minimum age of e-cigarette sales), young adults (21–24 years old), and adults (25–40 years old). The participants reported using e-cigarettes ever (44.2% < 21; 67.1% 21–24; 58.0% > 24), in the past 30 days (29.8% < 21; 52.6% 21–24; 43.3% > 24), and in the past 7 days (24.5% < 21; 43.9% 21–24; 36.5% > 24). Disposables were the most used e-cigarette device type across age groups (39.1% < 21; 36.9% 21–24; 34.5% > 24). Fruit, sweet, mint, and menthol flavors were popular across age groups; however, chi-squared tests for trends in proportions revealed age-related trends in past 30-day flavor use by device type. Findings suggest current AYA e-cigarette use may be higher than recorded by the NYTS 2021. The FDA, states, and localities should adopt more comprehensive restrictions on flavored e-cigarette products in order to reduce adolescent and young adult e-cigarette use. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
14 pages, 5945 KiB  
Article
Smartphone Application for Smoking Cessation (Quit with US): A Randomized Controlled Trial among Young Adult Light Smokers in Thailand
by Phantara Chulasai, Dujrudee Chinwong, Purida Vientong, Sunee Lertsinudom, Penkarn Kanjanarat, John J. Hall and Surarong Chinwong
Int. J. Environ. Res. Public Health 2022, 19(14), 8265; https://doi.org/10.3390/ijerph19148265 - 6 Jul 2022
Cited by 15 | Viewed by 2372
Abstract
This study aimed to determine the efficacy of a smartphone application named Quit with US among young adult smokers. An open-label, parallel, 2-group, randomized controlled trial with a 12-week follow-up was conducted between March and November 2020 among undergraduate students (18 to 24 [...] Read more.
This study aimed to determine the efficacy of a smartphone application named Quit with US among young adult smokers. An open-label, parallel, 2-group, randomized controlled trial with a 12-week follow-up was conducted between March and November 2020 among undergraduate students (18 to 24 years) in Chiang Mai Province, Thailand. A total of 273 participants were assigned by simple randomization procedure to the Quit with US intervention group (n = 137) or the control group (n = 136). All participants received pharmacists’ smoking cessation counseling at baseline and follow-ups. In addition, the intervention group’s participants were advised to use Quit with US. The baseline and 12-week follow-up assessments were conducted at a study unit, whereas other follow-ups were completed over the telephone. The primary abstinence outcome was the exhaled CO concentration level (≤6 ppm) verified 7-day point prevalence abstinence. At baseline, the participants’ mean (standard deviation) age was 21.06 (1.62) years. Most identified as daily smokers (57.9%, n = 158), consumed ≤10 cigarettes daily (89.4%, n = 244), and expressed low level of nicotine dependence as measured by Heaviness of Smoking Index score (86.1%, n = 235). Regarding intention-to-treat analyses, participants in the Quit with US intervention group achieved significantly greater smoking abstinence rate than those in the control group (58.4% (80/137) vs. 30.9% (42/136), risk ratio = 1.89, 95% confidence intervals = 1.42 to 2.52, p < 0.001). In conclusion, Quit with US integrated with pharmacists’ smoking cessation counseling significantly enhanced smoking abstinence rates among young adult light smokers consuming ≤ 10 cigarettes daily. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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12 pages, 323 KiB  
Article
Characterizing Participant Perceptions about Smoking-Cessation Pharmacotherapy and E-Cigarettes from Facebook Smoking-Cessation Support Groups
by Allison Lee, Angela A. Chang, Joanne Chen Lyu, Pamela M. Ling and Stephanie L. Hsia
Int. J. Environ. Res. Public Health 2022, 19(12), 7314; https://doi.org/10.3390/ijerph19127314 - 14 Jun 2022
Cited by 2 | Viewed by 2146
Abstract
The prevalence of smoking among young adults aged 19–28 years old in the United States persists at rates of 14.3%. Young adults underutilize pharmacotherapy for smoking cessation, and the use of e-cigarettes has increased. We analyzed comments from online smoking-cessation support groups to [...] Read more.
The prevalence of smoking among young adults aged 19–28 years old in the United States persists at rates of 14.3%. Young adults underutilize pharmacotherapy for smoking cessation, and the use of e-cigarettes has increased. We analyzed comments from online smoking-cessation support groups to understand young-adult smokers’ views of pharmacotherapy and e-cigarettes, to provide a more in-depth insight into the underutilization of pharmacotherapy. A qualitative analysis was performed on comments about pharmacotherapy and e-cigarettes from participants enrolled in online smoking-cessation support groups in 2016–2020. A codebook was developed with a deductive approach to code the comments, followed by thematic analysis. Eighteen themes were identified, with four dominant themes: interest, benefit, knowledge, and flavor. Participants expressed less interest in both nicotine-replacement therapy and e-cigarettes; moreover, they expressed unfamiliarity with and misconceptions about pharmacotherapy, and recognized the enticing flavors of e-cigarettes. Participants often felt e-cigarettes were not useful for smoking cessation, but the flavors of e-cigarettes were appealing for use. Participants had mixed opinions about the use of e-cigarettes for smoking cessation, but predominantly felt e-cigarettes were not useful for smoking cessation. The use of social media may be an effective way to address misconceptions about pharmacotherapy for smoking cessation and increase willingness to accept assistance. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
12 pages, 341 KiB  
Article
Exploring the Experiences and Perceptions of Cigar Craving and Addiction among Young Adult Black Cigar Smokers
by Maryam Elhabashy, Lilianna Phan, Kristen R. Hamilton-Moseley, Aaron Broun, Danielle A. Duarte, Aniruddh Ajith, Bambi Jewett, Erin L. Mead-Morse, Kelvin Choi and Julia Chen-Sankey
Int. J. Environ. Res. Public Health 2022, 19(11), 6680; https://doi.org/10.3390/ijerph19116680 - 30 May 2022
Cited by 3 | Viewed by 1695
Abstract
Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, [...] Read more.
Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, and perceived addiction from cigar smoking among a purposive sample of Black young adult cigar smokers (N = 40; 21–29 years). An iterative process was used to develop the codebook, and thematic analysis was used to capture findings based on the products predominantly used: cigarillos, large cigars, or blunts. Results suggest that while participants may share similar types of cravings and triggers (e.g., stress) across the use of these products, predominant blunt smokers reported more unique triggers related to relieving physical discomforts. While most participants reported cigars could be addictive to people in general, only a few perceived that they themselves were addicted. Participants who predominantly smoked cigarillos reported high perceived addiction to cigars, while those who predominantly smoked blunts reported low addiction. Education messages are needed to inform young Black adult cigar smokers about the risks and health symptoms of cigar addiction. These efforts may help increase cigar cessation seeking and reduce cigar addiction-related health consequences and disparities among Black populations. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
10 pages, 844 KiB  
Article
Use of Tobacco and Nicotine Products among Young People in Denmark—Status in Single and Dual Use
by Lotus Sofie Bast, Marie Borring Klitgaard, Simone Gad Kjeld, Nanna Schneekloth Jarlstrup and Anne Illemann Christensen
Int. J. Environ. Res. Public Health 2022, 19(9), 5623; https://doi.org/10.3390/ijerph19095623 - 5 May 2022
Cited by 6 | Viewed by 2098
Abstract
Lots of new tobacco or nicotine products are being launched, e.g., e-cigarettes and smokeless tobacco, which appeal especially to the youngest part of the population. For example, the use of smokeless tobacco among Danish youth rose from approx. 2% in 2010 to 9% [...] Read more.
Lots of new tobacco or nicotine products are being launched, e.g., e-cigarettes and smokeless tobacco, which appeal especially to the youngest part of the population. For example, the use of smokeless tobacco among Danish youth rose from approx. 2% in 2010 to 9% in 2020. Hence, there is an urgent need to follow and intervene against youth tobacco or nicotine product use. This study explored the current use of cigarettes, e-cigarettes, heated tobacco, and smokeless tobacco among Danish 15- to 29-year-olds. Further, we examined the concurrent use of two products or more. We used a nationwide survey conducted among 15- to 29-year-olds in February and March 2020. Overall, approx. 35,700 individuals received the questionnaire of which 35.5% responded (n = 13,315). One out of five (20.1%) smoked cigarettes, half of them daily, the other half occasionally. About one in twenty (3.9%) used e-cigarettes (daily or occasionally), and more than one in three (31.6%) had tried e-cigarettes. The use of heated tobacco among Danish youth is still relatively limited (0.3%). In comparison, about 9% used smokeless tobacco (daily or occasionally). Overall, 27.0% stated that they use at least one type of tobacco or nicotine product, while 5.6% used more than one product. Monitoring tobacco-related behavior in youth provides extremely important information for, e.g., policymakers and health professionals. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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15 pages, 355 KiB  
Article
Physical and Sociocultural Community-Level Influences on Cigar Smoking among Black Young Adults: An In-Depth Interview Investigation
by Aaron Broun, Lilianna Phan, Danielle A. Duarte, Aniruddh Ajith, Bambi Jewett, Erin L. Mead-Morse, Kelvin Choi and Julia Chen-Sankey
Int. J. Environ. Res. Public Health 2022, 19(8), 4430; https://doi.org/10.3390/ijerph19084430 - 7 Apr 2022
Cited by 4 | Viewed by 2248
Abstract
Black young adults experience disparately high rates of cigar use and its health consequences. Little research has explored community-level influences on cigar smoking in this population, especially concerning product-specific influences and cigar smokers’ perceptions. We conducted in-depth interviews with 40 Black young adult [...] Read more.
Black young adults experience disparately high rates of cigar use and its health consequences. Little research has explored community-level influences on cigar smoking in this population, especially concerning product-specific influences and cigar smokers’ perceptions. We conducted in-depth interviews with 40 Black young adult (ages 21–29) cigar smokers in the Washington, D.C. area and analyzed themes regarding physical and sociocultural community-level factors perceived to influence cigar use. Themes were further analyzed based on participants’ predominant cigar products (cigarillos, large cigars, blunts). Participants reported easy access to affordable cigarillos, widespread cigarillo sales and targeted marketing, norms of cigar and blunt smoking for stress relief, socialization, and cultural participation, and ubiquitous cigar and blunt smoking cues, all of which promoted cigar use in their communities. Future research should further explore how community-level influences contribute to disproportionate cigar use among Black young adults. Our findings suggest that programs and policies addressing physical and sociocultural community-level pro-smoking influences may help mitigate cigar smoking disparities. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
13 pages, 353 KiB  
Article
Online E-Cigarette Information Exposure and Its Association with E-Cigarette Use among Adolescents in Shanghai, China
by Luojia Dai, Yaping He, Yinliang Tan, Zhiping Yu and Jingfen Zhu
Int. J. Environ. Res. Public Health 2022, 19(6), 3329; https://doi.org/10.3390/ijerph19063329 - 11 Mar 2022
Cited by 12 | Viewed by 3103
Abstract
E-cigarettes are widely advertised, while the potential risks of e-cigarette use have been reported among adolescents. This study assessed online e-cigarette information exposure and its association with adolescents’ e-cigarette use in Shanghai, China. A total of 12,470 students aged 13–18 years participated. A [...] Read more.
E-cigarettes are widely advertised, while the potential risks of e-cigarette use have been reported among adolescents. This study assessed online e-cigarette information exposure and its association with adolescents’ e-cigarette use in Shanghai, China. A total of 12,470 students aged 13–18 years participated. A questionnaire collected information on students’ sociodemographic factors, e-cigarette information exposure, cigarette use, e-cigarette use, and e-cigarette use intention. A multivariate logistic regression was performed to assess correlates of exposure to e-cigarette information and the association between e-cigarette information exposure and e-cigarette use. Overall, 73.9% of students knew about e-cigarettes and the primary sources of information were the internet (42.4%), movies/TV (36.4%), bulletin boards in retail stores or supermarkets (34.9%), advertising flyers (33.9%), and friends (13.8%). Students who had friends using e-cigarettes were curious about e-cigarettes and showed a greater monthly allowance; smokers and females were at a higher risk of social media and website exposure. Moreover, online information exposure (social media exposure, website exposure, and total internet exposure) was significantly associated with the intention to use e-cigarettes. The enforcement of regulations on online e-cigarette content should be implemented. Moreover, efforts to prevent young people from using e-cigarettes may benefit from targeting students at a higher risk of online e-cigarette information exposure. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
11 pages, 940 KiB  
Article
Unpacking Cigar Product Familiarity and Terminology among Black and Hispanic Youth: It’s All about Blunts
by Dawnyéa D. Jackson, Emily C. Sanders, Molly Barry, Dana E. Wagner, Megan Wall Vigorita and Mario A. Navarro
Int. J. Environ. Res. Public Health 2022, 19(3), 1689; https://doi.org/10.3390/ijerph19031689 - 1 Feb 2022
Cited by 3 | Viewed by 2510
Abstract
The prevalence rate of Cigar, Little Cigar, and Cigarillo (CLCC) use among youth rose above the rate of cigarettes for the first time in 2019, and Black and Hispanic youth remain disproportionately more susceptible and likely to use these products compared to White [...] Read more.
The prevalence rate of Cigar, Little Cigar, and Cigarillo (CLCC) use among youth rose above the rate of cigarettes for the first time in 2019, and Black and Hispanic youth remain disproportionately more susceptible and likely to use these products compared to White youth. Addressing this disparity through education requires a clearer understanding of the ways youth refer to, and group, CLCCs. Twenty-eight virtual focus groups with youth ages 13–17 (n = 105) were conducted across the U.S. Groups were split by race/ethnicity, with 14 Black and 14 Hispanic groups, and further divided by CLCC experimenters and susceptible users. Youth participants discussed CLCC use behaviors, harm and risk perceptions, and knowledge, attitudes, and beliefs about CLCC products. When shown photos of CLCC products during focus groups, youth across groups identified and labeled these products into four subcategories. Large cigars were universally labeled “cigars”. Little cigars were unfamiliar and guessed to be cigarettes. Tipped cigarillos were synonymous with the brand Black and Mild and considered tobacco. Untipped cigarillos were most referred to as “blunts” and used with marijuana. Understanding the nuances of language and use patterns of CLCCs is critical to ensuring the accuracy of measurement and impact of public health communications. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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11 pages, 991 KiB  
Article
Single, Dual, and Triple Use of Cigarettes, e-Cigarettes, and Snus among Adolescents in the Nordic Countries
by Kirsimarja Raitasalo, Elin K. Bye, Charlotta Pisinger, Janne Scheffels, Rikke Tokle, Jaana M. Kinnunen, Hanna Ollila and Arja Rimpelä
Int. J. Environ. Res. Public Health 2022, 19(2), 683; https://doi.org/10.3390/ijerph19020683 - 7 Jan 2022
Cited by 9 | Viewed by 3050
Abstract
New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, [...] Read more.
New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, dual, and triple use of cigarettes, e-cigarettes, and snus among Nordic adolescents, using data of 15–16-year-olds (n = 16,125) from the European School Survey Project on Alcohol and other Drugs (ESPAD) collected in 2015 and 2019 from Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands. Country-specific lifetime use of any of these products ranged between 40% and 50%, and current use between 17% and 31%. Cigarettes were the most common product in all countries except for Iceland, where e-cigarettes were remarkably more common. The proportion of dual and triple users was unexpectedly high among both experimental (24%–49%) and current users (31–42%). Triple use was less common than dual use. The users’ patterns varied somewhat between the countries, and Iceland differed substantially from the other countries, with a high proportion of single e-cigarette users. More knowledge on the patterns of multiple use of tobacco and nicotine products and on the potential risk and protective factors is needed for targeted intervention and prevention efforts. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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10 pages, 1954 KiB  
Article
Point of Sale Advertising and Promotion of Cigarettes, Electronic Cigarettes, and Heated Tobacco Products in Warsaw, Poland—A Pilot Study
by Paweł Koczkodaj, Paloma Cuchi, Agata Ciuba, Elwira Gliwska and Armando Peruga
Int. J. Environ. Res. Public Health 2021, 18(24), 13002; https://doi.org/10.3390/ijerph182413002 - 9 Dec 2021
Cited by 1 | Viewed by 2703
Abstract
Prevalence of smoking and e-cigarette use among teenagers in Poland is high. Polish law bans most advertising and promotion for cigarettes, e-cigarettes, and heated tobacco products (HTPs). This study investigates marketing for these products at points of sale (POS) near secondary schools in [...] Read more.
Prevalence of smoking and e-cigarette use among teenagers in Poland is high. Polish law bans most advertising and promotion for cigarettes, e-cigarettes, and heated tobacco products (HTPs). This study investigates marketing for these products at points of sale (POS) near secondary schools in Warsaw, Poland, noting if the advertising and promotion were allowed under current Polish laws. All POS within 250 m radii of five selected secondary schools in each of three Warsaw districts were assessed for tobacco and e-cigarette direct advertising, inside and outside; offers of gifts or promotional discounts; tobacco merchandising, and tobacco displays. Of the 112 POS surveyed, 83% exposed customers to some form of advertising or promotion of cigarettes, e-cigarettes, or HTPs; in 76%, advertising or promotion that violated Polish law was present. More than 80% of POS surveyed displayed tobacco products; in 19%, these products were displayed near products of interest to minors. POS density observed here was 30.3 per km2, higher than in other European cities. In Poland, a high proportion of POS near schools violates the law banning the advertisement and promotion of tobacco and nicotine consumer products through a dense tobacco retailer network. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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15 pages, 24846 KiB  
Article
Optimizing Images for an E-Cigarette Messaging Campaign: Liking and Perceived Effectiveness
by Elise M. Stevens, Brittney Keller-Hamilton, Darren Mays, Jennifer B. Unger, Olivia A. Wackowski, Julia C. West and Andrea C. Villanti
Int. J. Environ. Res. Public Health 2021, 18(24), 12989; https://doi.org/10.3390/ijerph182412989 - 9 Dec 2021
Viewed by 1772
Abstract
Introduction: Given the prevalence of electronic vapor product (EVP) use among young people in the US, there is a need for effective vaping education campaigns. This study tested 32 images for liking and perceived effectiveness (PE) to identify optimal images for a messaging [...] Read more.
Introduction: Given the prevalence of electronic vapor product (EVP) use among young people in the US, there is a need for effective vaping education campaigns. This study tested 32 images for liking and perceived effectiveness (PE) to identify optimal images for a messaging campaign. Method: Images were selected from current campaigns, warning labels, and other images based on young adult reasons for use. Images were coded for the presence of (1) people, (2) vapor, (3) device, (4) color, and (5) similarity to warning label image. Young adults (n = 200) were recruited from the Amazon Mechanical Turk platform. Participants were randomly assigned to view and rate six of the 32 images on liking as well as PE, which measured the potential impact of the image to discourage vaping appeal and use. Results: Images containing vapor and/or a device or e-liquid were not well-liked but were perceived as effective in discouraging vaping (ps < 0.05). Images from warning labels were also not well-liked but were perceived as significantly more effective than those not from a warning (p < 0.01). Liking and effectiveness of features was similar for both EVP users and non-users. Discussion: Images with specific features were rated as less likable but rated as higher on PE. However, the consistency of image features rated as effective by EVP users and non-users supports the utility of similar imagery for vaping prevention and reduction efforts. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
12 pages, 665 KiB  
Article
Age of Initiation of Dual Tobacco Use and Binge Drinking among Youth (12–17 Years Old): Findings from the Population Assessment of Tobacco and Health (PATH) Study
by Adriana Pérez, Arnold E. Kuk, Meagan A. Bluestein, Hui Min Shirlyn Sia and Baojiang Chen
Int. J. Environ. Res. Public Health 2021, 18(24), 12985; https://doi.org/10.3390/ijerph182412985 - 9 Dec 2021
Cited by 3 | Viewed by 2105
Abstract
Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and [...] Read more.
Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7–5.2) and 2.0% (95% CI: 1.2–2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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16 pages, 964 KiB  
Article
Sociodemographic Patterns of Exclusive and Dual Use of ENDS and Menthol/Non-Menthol Cigarettes among US Youth (Ages 15–17) Using Two Nationally Representative Surveys (2013–2017)
by Akash Patel, Jana L. Hirschtick, Steven Cook, Bukola Usidame, Ritesh Mistry, David T. Levy, Rafael Meza and Nancy L. Fleischer
Int. J. Environ. Res. Public Health 2021, 18(15), 7781; https://doi.org/10.3390/ijerph18157781 - 22 Jul 2021
Cited by 6 | Viewed by 4476
Abstract
The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. [...] Read more.
The use of electronic nicotine delivery systems (ENDS) among youth in the United States has increased rapidly in the past decade. Simultaneously, while youth cigarette smoking has declined considerably, youth are still more likely to use menthol cigarettes than any other age group. We used nationally representative data on 15–17-year-olds from the Population Assessment of Tobacco and Health (PATH) Study and the National Youth Tobacco Survey (NYTS) (2013–2017) to better understand current cigarette (by menthol flavoring) and ENDS use in the US. We calculated weighted population prevalence estimates across years for multiple patterns of current cigarette and ENDS use (i.e., exclusive menthol cigarette, exclusive non-menthol cigarette, exclusive ENDS, dual ENDS and menthol cigarette, and dual ENDS and non-menthol cigarette) by sex, race/ethnicity, parental education level, household income, and homeownership. Overall, both exclusive menthol and non-menthol cigarette use declined from 2013–2017. Exclusive ENDS use increased, particularly among youth who were non-Hispanic White or had a higher socioeconomic status (measured by parental education, household income, and homeownership). Dual use of ENDS with either menthol or non-menthol cigarettes did not change significantly. Monitoring changes in these sociodemographic patterns will help inform future youth tobacco prevention strategies. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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12 pages, 870 KiB  
Article
Sex Difference in the Association between Electronic Cigarette Use and Subsequent Cigarette Smoking among U.S. Adolescents: Findings from the PATH Study Waves 1–4
by Zongshuan Duan, Yu Wang and Jidong Huang
Int. J. Environ. Res. Public Health 2021, 18(4), 1695; https://doi.org/10.3390/ijerph18041695 - 10 Feb 2021
Cited by 17 | Viewed by 3323
Abstract
E-cigarettes are the most-used tobacco products among U.S. adolescents. Emerging evidence suggests that adolescents using e-cigarettes are at elevated risk for initiating cigarette smoking. However, whether this risk may differ by sex remains unknown. This study analyzed data from Wave 1 to 4 [...] Read more.
E-cigarettes are the most-used tobacco products among U.S. adolescents. Emerging evidence suggests that adolescents using e-cigarettes are at elevated risk for initiating cigarette smoking. However, whether this risk may differ by sex remains unknown. This study analyzed data from Wave 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal survey. Generalized estimation equations (GEE) were performed to estimate the associations between baseline e-cigarette use and subsequent cigarette smoking, controlling for sociodemographic characteristics, mental health conditions, and other tobacco use. Effect modifications by sex were examined. Multivariate analyses showed that, among baseline never cigarette smokers, past-30-day e-cigarette use at baseline waves was significantly associated with past-30-day cigarette smoking at follow-up waves (aOR = 3.90, 95% CI: 2.51–6.08). This association was significantly stronger for boys (aOR = 6.17, 95% CI: 2.43–15.68) than for girls (aOR = 1.10, 95% CI: 0.14–8.33). Additionally, using other tobacco products, older age, and having severe externalizing mental health problems at baseline were significantly associated with an increased likelihood of cigarette smoking at follow-up. The prospective association between e-cigarette use and cigarette smoking differs by sex among U.S. adolescents. Sex-specific tobacco control interventions may be warranted to curb the youth tobacco use epidemic. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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9 pages, 848 KiB  
Article
Toward a More Comprehensive Index of Youth Cigarette Smoking: Average Number of Cigarettes Smoked per Day among Students in the United States over Two Decades
by Michelle T. Bover Manderski, Cristine D. Delnevo and Kenneth E. Warner
Int. J. Environ. Res. Public Health 2021, 18(2), 478; https://doi.org/10.3390/ijerph18020478 - 8 Jan 2021
Cited by 6 | Viewed by 2867
Abstract
Reliance on 30-day prevalence as the principal means of assessing trends in youth cigarette smoking may understate the magnitude of the decrease in youth smoking, because prevalence does not account for smoking frequency or intensity. We analyzed Youth Risk Behavior Survey (YRBS) data [...] Read more.
Reliance on 30-day prevalence as the principal means of assessing trends in youth cigarette smoking may understate the magnitude of the decrease in youth smoking, because prevalence does not account for smoking frequency or intensity. We analyzed Youth Risk Behavior Survey (YRBS) data from 1997 through 2017 and estimated cigarette smoking prevalence (any smoking in the previous 30 days), frequency (number of smoking days in the previous 30 days), and intensity (cigarettes per day on smoking days). We calculated average cigarettes smoked per day (ACSD) as the product of frequency and intensity, divided by 30. We estimated ACSD among all high school students and by smoking frequency group (i.e., 1–5, 6–9, 10–19, 20–29, or 30 of the previous 30 days), sex, grade level, and race/ethnicity. Among US high school students, ACSD declined by 86.7% from 1997 to 2017, while prevalence declined by 75.8%. Within smoking frequency groups, smoking intensity remained similar over the two decades. However, changes in ACSD over time varied by race/ethnicity; ACSD increased among Hispanic and non-Hispanic Black daily smokers while it decreased among daily smokers of other race/ethnicity groups. ACSD declined more substantially than smoking prevalence over two decades but remained virtually unchanged within smoking frequency groups, indicating that changes in frequency, rather than intensity, drove this decline. Prevalence estimates alone understate the degree to which youth in the United States have rejected smoking, and racial/ethnic disparities in smoking intensity are hidden when we limit our lens to prevalence-only measures. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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Review

Jump to: Research, Other

10 pages, 758 KiB  
Review
Factors Associated with E-Cigarette Escalation among High School Students: A Review of the Literature
by Michael Short and Adam Geoffrey Cole
Int. J. Environ. Res. Public Health 2021, 18(19), 10067; https://doi.org/10.3390/ijerph181910067 - 25 Sep 2021
Cited by 5 | Viewed by 5663
Abstract
Background: E-cigarette use has been identified as a behaviour of concern among adolescents, and ever and daily use among this population has increased recently. The purpose of this review was to summarize the relevant studies investigating the frequency and intensity of e-cigarette use [...] Read more.
Background: E-cigarette use has been identified as a behaviour of concern among adolescents, and ever and daily use among this population has increased recently. The purpose of this review was to summarize the relevant studies investigating the frequency and intensity of e-cigarette use in adolescents and the factors associated with these patterns of use. Methods: A scoping search of two databases was conducted to identify longitudinal studies examining escalating e-cigarette use among adolescents. Escalating e-cigarette use could refer to an increasing frequency or intensity of use over time. Articles were screened for relevance. Studies that met inclusion criteria were included for synthesis. Results: Five articles were included for synthesis. All five articles were longitudinal studies taking place in the United States between 2013 and 2017. Age, gender, cost of e-cigarettes, use of cigarettes, polysubstance use, and e-liquid nicotine concentration were associated with escalation of e-cigarette use. Conclusions: A paucity of information exists regarding the escalation of e-cigarette use among adolescents. Given the changing popularity of devices, additional updated evidence is needed to understand the factors associated with the escalation of e-cigarette use among adolescents, which can be used to inform local and national programs and policies. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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Other

Jump to: Research, Review

9 pages, 336 KiB  
Brief Report
Nicotine Dependence from Different E-Cigarette Devices and Combustible Cigarettes among US Adolescent and Young Adult Users
by Crystal Lin, Shivani Mathur Gaiha and Bonnie Halpern-Felsher
Int. J. Environ. Res. Public Health 2022, 19(10), 5846; https://doi.org/10.3390/ijerph19105846 - 11 May 2022
Cited by 14 | Viewed by 2723
Abstract
E-cigarettes, the most popular tobacco product among adolescents, vary widely in design and nicotine composition; thus, different devices may have different addictive potential. However, few studies examine levels of nicotine dependence across devices among adolescent and young adult (AYA) e-cigarette users. To assess [...] Read more.
E-cigarettes, the most popular tobacco product among adolescents, vary widely in design and nicotine composition; thus, different devices may have different addictive potential. However, few studies examine levels of nicotine dependence across devices among adolescent and young adult (AYA) e-cigarette users. To assess the extent of nicotine dependence among US AYA (ages 13–24) by e-cigarette device type, we conducted a large, national, cross-sectional survey (n = 4351) and used the Hooked on Nicotine Checklist (HONC) to assess levels of nicotine dependence among those who had used disposable, pod-based, and/or mods/other e-cigarette devices in the past 30 days. We also examined HONC scores among those who had used combustible cigarettes in the past 30 days, whether with or without using e-cigarettes. Patterns of nicotine dependence were comparable across those who had used a combustible cigarette and/or e-cigarette in the past 30 days, with 91.4% of combustible cigarette users, 80.7% of disposable e-cigarette users, 83.1% of pod-based e-cigarette users, and 82.5% of mods/other e-cigarette users showing signs of nicotine dependence, as measured by endorsing at least one HONC symptom. This pattern persisted when analyses were restricted to e-cigarette only users, with more than 70% of all e-cigarette only past-30-day users endorsing at least one HONC symptom, across all types of devices. A thorough understanding of the extent and presentation of nicotine dependence among AYA will help researchers, public health officials, and clinicians recognize and manage AYA nicotine dependence. Full article
(This article belongs to the Special Issue Addressing Tobacco and Nicotine Use among Adolescent and Young Adult Populations)
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