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Background: Despite recent tobacco control efforts, adolescent vaping remains an epidemic in the United States. The purpose of our study was to understand high school student vaping behaviors using the perceptions of Massachusetts school personnel during the critical window from when the Massachusetts statewide flavor ban legislation was passed in November 2019 through the first year of the COVID-19 pandemic. Methods: High school personnel throughout Massachusetts were invited to complete a cross-sectional survey. Analysis of survey responses was conducted in R. Results: A total of 162 respondents completed the survey representing 137 schools that draw enrollments from 216 (61%) of the 352 cities and towns in Massachusetts. The most popular products that respondents believed their students were using were JUULs (95.7%), other e-cigarettes (85.3%), and disposable vapes (79.6%). Following the flavor ban, the majority (90.7%) did not report an increase in combusted tobacco product use. All participants (100%) reported wanting more access to prevention and treatment resources. Conclusions: Our findings suggest that a comprehensive flavor ban may be an effective tobacco control policy that does not appear to promote student switching from vaping products to combusted tobacco products. These data also indicate that schools report needing additional resources to address the vaping epidemic.

Introduction Current measures of vaping behaviors in the U.S. do not distinguish what substances participants are vaping and to what extent they are dual-vaping nicotine and cannabis. This study describes the use of new survey questions that more specifically ask whether participants who vape are vaping nicotine, cannabis, cannabidiol (CBD), or another substance. Aims and Methods Adults, who reported any past 30-day tobacco use, from five New England states participated in an online survey from April 2021 to July 2022. Participants who vaped were asked, "Have you used any of the following vape substances in the past 30 days?" with the possible responses of nicotine, cannabis, CBD, other, and "don't know." Dual use of both nicotine and cannabis was defined as the vaping of both nicotine and cannabis and/or CBD in the past 30 days, operationalized as a dichotomous outcome. Data were collected in monthly, repeated cross-sectional waves. Multinomial logistic regression was used to examine correlates of dual-vaping. Results The analytic sample included 1547 adults who reported past 30-day tobacco use (mean age 42.9 years, 62.8% female, 85.4% White, 48.5% income of less than $50 000). Over one-quarter (26.1%) reported dual-vaping in the past 30 days. Identifying as male (p  = .002) and self-rated anxiety (p  = .043) were associated with a higher odds of dual-vaping. Conclusions Our findings show that a sizable proportion of a sample of New England adults who have used tobacco in the past 30 days are dual-vaping nicotine and cannabis. Adequate survey measures for assessing the vaping of multiple substances can help in better screening and characterization of health behaviors around dual-use. Implications This study addresses a key gap in adequate survey measures for assessing vaping of multiple substances. We found that among adults with past 30-day tobacco use, dual-vaping was prevalent and associated with different correlates, such as self-reported anxiety and education level, compared to sole-vaping of nicotine or cannabis. Our findings may help in characterizing and targeting future population-level surveillance and intervention efforts for multiple substance use behaviors. [ABSTRACT FROM AUTHOR]

Introduction Increasing electronic cigarette use among youth has led to a need for a novel intensity measure of e-cigarette use and its association with nicotine addiction variables. Aims and Methods Using a cross-sectional study of the 2018–2019 PATH Wave 5 Youth survey, a new intensity metric of e-cigarette use, the average number of puffs per month as a function of frequency (days of use per month), number of uses per day and number of puffs per use, was developed for adolescent e-cigarette users. Using logistic regression, standard addiction measures were tested for association with higher quartile (Q) of e-cigarette intensity: Q 1 (1–5 puffs), Q 2 (6–50 puffs), Q 3 (51–528 puffs), and Q 4 (529 + puffs). Results Among 1051 current youth e-cigarette users, cravings were associated with greater intensity of use (Q 2: aOR = 1.90, 95% CI: 0.94–3.87; Q 3: aOR = 6.91, 95% CI: 3.25–14.69; and Q4: aOR = 21.48, 95% CI: 10.03–45.97). Craving associations exceeded the corresponding aORs for the identical regression using the frequency of use. Higher intensity was significantly associated with being an older adolescent (aOR = 1.85), best friend use (aOR: 3.35), not thinking about quitting (aOR: 2.51), and lower perceived addiction (aOR: 1.95). Conclusions This study found that an intensity metric (puffs per month) was strongly associated with cravings, best friend use, harm perception, and lack of intention to quit. This metric provides a more accurate picture of the intensity of youth e-cigarette use than other commonly used measures and may be important for understanding the current and future impact of the youth e-cigarette epidemic. Implications Adolescent addiction to e-cigarettes affects learning, memory, and attention. However, it is unknown whether the intensity of use, puffs per month, differs from frequency, days of use per month, and in relation to addiction measures. This study provides evidence that high-intensity use characterized by puffs per month has a stronger association with cravings compared to frequency, which suggests puffs per month may be a better measure of nicotine exposure. This new intensity metric may give insights into youth e-cigarette use patterns, addiction, and appropriate treatment of intense but intermittent users. [ABSTRACT FROM AUTHOR]

Introduction: The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment. Aims and Methods: This study explores key informants' perceptions of intended and unintended impacts of implementation of the 2019 Massachusetts statewide law through a health equity and racial justice lens. We conducted in-depth interviews with 25 key informants from three key informant groups (public health officials and advocates, clinicians, and school staff) between March 2021 and April 2022. Using deductive codes on unintended impacts of the implementation of the law's policies, we conducted a focused analysis to identify impacts that were perceived and observed by informants from different key informant groups. Results: Perceived or observed impacts of the law were identified across multiple levels by key informants and included concerns related to three broad themes: 1) intended impacts on health equity and racial justice, 2) ongoing availability of restricted products undermining the intended impact of the law, and 3) inequitable targeting by the policies and enforcement among communities of color. Conclusions: Future evaluation is needed to assess the intended and unintended impacts of implementation of the Massachusetts law to maximize the potential of the policies to reduce tobacco-related health disparities. We discuss implications and recommendations for achieving a national policy and equitable enforcement of flavored tobacco sales restrictions. Implications: This qualitative study among 25 key informants including public health and tobacco control advocates, clinicians, and school staff obtained perspectives of intended and unintended health equity and racial justice impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Findings and recommendations from this study can inform monitoring efforts to assess the law's impacts in Massachusetts and the adoption of similar flavored tobacco sales restrictions and other tobacco control policies in other states to maximize the health equity benefits and minimize unintended impacts. [ABSTRACT FROM AUTHOR]

INTRODUCTION Effective tobacco treatments are available but are often not delivered to individuals with an actual or potential diagnosis of thoracic malignancy. The specific aims of this study were to identify the prevalence of tobacco use and examine the effectiveness of the Clinical and community Effort Against Smoking and secondhand smoke Exposure (CEASE), a system-level computer-facilitated intervention, to improve provider delivery of tobacco treatment in a thoracic surgery and oncology outpatient setting. METHODS A pre-post-test design was used to assess the effectiveness of CEASE. A 3-step approach was used to integrate tobacco treatment into routine care: ask about tobacco use, assist with cessation, and refer to a quitline. An end-of-visit survey was conducted to collect prevalence of tobacco use and delivery of tobacco treatment. Descriptive statistics and Fisher's exact test were used for analysis. RESULTS A total of 218 individuals were enrolled; 105 participants were in usual care (UC) and 113 were in the CEASE group. Of those who enrolled, 27.6% were never smokers in UC and 27.7% in CEASE, 60% were former smokers in UC and 50% in CEASE, and 12.4% were current smokers in UC and 21.4% in CEASE. Significant differences were noted in delivery of tobacco treatment with 15.4% having received tobacco treatment in UC compared to 62.5% in CEASE (p<0.004). CONCLUSIONS A computer-facilitated intervention increased provider delivery of tobacco treatment in a thoracic surgery and oncology outpatient setting. This intervention provided a low-resource approach that has the potential to be scaled and implemented more broadly. [ABSTRACT FROM AUTHOR]

Abstract Background Role conflict can motivate behavior change. No prior studies have explored the association between parent/smoker role conflict and readiness to quit. The objective of the study is to assess the association of a measure of parent/smoker role conflict with other parent and child characteristics and to test the hypothesis that parent/smoker role conflict is associated with a parent’s intention to quit smoking in the next 30 days. As part of a cluster randomized controlled trial to address parental smoking (Clinical Effort Against Secondhand Smoke Exposure—CEASE), research assistants completed exit interviews with 1980 parents whose children had been seen in 20 Pediatric Research in Office Settings (PROS) practices and asked a novel identity-conflict question about “how strongly you agree or disagree” with the statement, “My being a smoker gets in the way of my being a parent.” Response choices were dichotomized as “Strongly Agree” or “Agree” versus “Disagree” or “Strongly Disagree” for the analysis. Parents were also asked whether they were “seriously planning to quit smoking in 30 days.” Chi-square and logistic regression were performed to assess the association between role conflict and other parent/children characteristics. A similar strategy was used to determine whether role conflict was independently associated with intention to quit in the next 30 days. Methods As part of a RTC in 20 pediatric practices, exit interviews were held with smoking parents after their child’s exam. Parents who smoked were asked questions about smoking behavior, smoke-free home and car rules, and role conflict. Role conflict was assessed with the question, “Please tell me how strongly you agree or disagree with the statement: ‘My being a smoker gets in the way of my being a parent.’ (Answer choices were: “Strongly agree, Agree, Disagree, Strongly Disagree.”) Results Of 1980 eligible smokers identified, 1935 (97%) responded to the role-conflict question, and of those, 563 (29%) reported experiencing conflict. Factors that were significantly associated with parent/smoker role conflict in the multivariable model included: being non-Hispanic white, allowing home smoking, the child being seen that day for a sick visit, parents receiving any assistance for their smoking, and planning to quit in the next 30 days. In a separate multivariable logistic regression model, parent/smoker role conflict was independently associated with intention to quit in the next 30 days [AOR 2.25 (95% CI 1.80-2.18)]. Conclusion This study demonstrated an association between parent/smoker role conflict and readiness to quit. Interventions that increase parent/smoker role conflict might act to increase readiness to quit among parents who smoke. Trial registration Clinical trial registration number: NCT00664261.

We assessed vaping behaviors, environments, COVID-19 influences, and barriers and facilitators of existing approaches that address adolescent vaping in Massachusetts middle and high schools. Findings from this study will provide considerations for individual schools or districts as they advance adolescent vaping prevention and treatment efforts. We analyzed 310 open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine semi-structured interviews with administrators (e.g. principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. Informed by Green's PRECEDE model, we conducted a framework analysis using deductive codes based on the model constructs (enabling, reinforcing, and predisposing factors) and inductive codes of key themes emerging from the interviews. Challenges to addressing adolescent vaping included staff capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Facilitators of vaping interventions included peer-led initiatives and parental involvement. Participants discussed the importance of educating adolescents on the harms of vaping and the move toward alternatives-to-suspension programs rather than disciplinary action. School-based anti-vaping program implementers—such as school districts, state departments of education, or local health departments—will need to leverage facilitators such as peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of these programs. [ABSTRACT FROM AUTHOR]

This JAMA Insights reviews the health effects of vaping among youth in the US and current recommendations for screening and treatment. [ABSTRACT FROM AUTHOR]

Introduction This study sought to examine reasons for youth e-cigarette use in association with vaping patterns and cessation behaviors. Aims and Methods A national representative sample of current (past 30-day) e-cigarette users in grades 6–12 was analyzed using the National Youth Tobacco Survey (NYTS), conducted from January to March 2020. An exploratory oblique factor analysis using a rotated pattern matrix to select salient variable-factor relationships yielded four subscales related to reasons for youth e-cigarette use. Multivariate logistic regressions were performed to assess the associations of each subscale with vaping patterns (frequent e-cigarette use, dual use of e-cigarettes and other tobacco products) and vaping cessation behaviors (intention to quit vaping and past-year quit attempts). Results The 2020 NYTS sampled 180 schools with 1769 current e-cigarette users. Four main reasons for vaping were identified through factor analysis, including (1) replacing cigarettes , (2) product characteristics [eg, flavors, concealability, and vape tricks ], (3) family/friend use , and (4) curiosity. Curiosity was associated with lower odds of frequent e-cigarette use (adjusted odds ratio [AOR] = 0.5, p <.0001) and dual use of e-cigarettes and other tobacco products (AOR = 0.6, p =.01) but higher odds of intention to quit (AOR = 1.2, p =.26) and past year quit attempts (AOR =1.5, p =.01). Vaping due to product characteristics was associated with higher odds of frequent e-cigarette use (AOR = 1.7, p <.0001) and lower odds of intention to quit (AOR = 0.3, p <.0001) and past year quit attempts (AOR = 0.9, p =.01). Conclusions Adolescents vape for various reasons that follow distinct patterns and user characteristics. Overall, interventions tailored to address heterogeneous reasons for vaping may help optimize the reduction in youth e-cigarette use. Implications E-cigarettes have surpassed cigarettes and become the most commonly used tobacco product by US youths. Adolescents choose to vape for different reasons. This study examined reasons for youth e-cigarette use and their associations with vaping patterns and cessation behaviors. The product characteristics factor (eg, flavors, concealability, and vape tricks) was associated with more frequent e-cigarette use and lower odds of cessation behaviors, suggesting a need for flavor bans and product design regulation. [ABSTRACT FROM AUTHOR]

Introduction. While many individuals quit smoking during pregnancy, most relapse within one year postpartum. Research into methods to decrease smoking relapse postpartum has been hampered by difficulties with recruitment. Method. We conducted individual interviews with pregnant women (N = 22) who were interested in quitting smoking while pregnant about their attitudes regarding smoking and quitting during pregnancy, clinical trial participation, and smoking cessation medication use. Results. Participants were aware of the risks of smoking while pregnant. Many wanted to quit smoking before delivery. Few used empirically supported treatments to quit. While research was viewed positively, interest in taking on new commitments postpartum and taking a medication to prevent relapse was low. Medication concerns were evident among most participants, especially among those planning to breastfeed. Further, several women noted medication was unnecessary, as they did not believe they would relapse postpartum. Financial incentives, childcare, and fewer and/or remote visits were identified as facilitators to participating in research. However, these factors did not outweigh women's concerns about medication use and time commitments. Conclusions. Women are aware that quitting smoking during pregnancy and remaining smoke-free postpartum are important. However, beliefs that personal relapse risk is low and that medications are dangerous reduced enthusiasm for taking medication for postpartum relapse prevention. Future medication trials should educate women about the high likelihood of relapse, prepare to answer detailed questions about risks of cessation medications, and connect with participants' clinicians. For new mothers, studies conducted remotely with few scheduled appointments would reduce barriers to participation. [ABSTRACT FROM AUTHOR]

The article discusses the current law concerning residential smoking regulations and their implementation by public housing authorities (PHAs). The debate on whether a nationwide ban on smoking in public housing would be desirable in achieving the set results is also highlighted.

BACKGROUND: Despite recent tobacco control efforts, adolescent vaping remains an epidemic in the United States. The purpose of our study was to understand high school student vaping behaviors using the perceptions of Massachusetts school personnel during the critical window from when the Massachusetts statewide flavor ban legislation was passed in November 2019 through the first year of the COVID‐19 pandemic. METHODS: High school personnel throughout Massachusetts were invited to complete a cross‐sectional survey. Analysis of survey responses was conducted in R. RESULTS: A total of 162 respondents completed the survey representing 137 schools that draw enrollments from 216 (61%) of the 352 cities and towns in Massachusetts. The most popular products that respondents believed their students were using were JUULs (95.7%), other e‐cigarettes (85.3%), and disposable vapes (79.6%). Following the flavor ban, the majority (90.7%) did not report an increase in combusted tobacco product use. All participants (100%) reported wanting more access to prevention and treatment resources. CONCLUSIONS: Our findings suggest that a comprehensive flavor ban may be an effective tobacco control policy that does not appear to promote student switching from vaping products to combusted tobacco products. These data also indicate that schools report needing additional resources to address the vaping epidemic. [ABSTRACT FROM AUTHOR]

INTRODUCTION Effective strategies are needed to facilitate collection of tobacco use information and integrate smoking cessation treatment into the routine care of all high-risk patient populations to improve clinical outcomes. The objective of this study was to establish the feasibility of collecting computer-facilitated patient-reported tobacco use, identify patient interest and preferences for smoking cessation in an outpatient thoracic surgery and oncology setting with higher prevalence of tobacco use than the general population. METHODS A brief patient-administered tobacco screening survey was handed out on an iPad in the waiting room of a thoracic surgery and oncology practice setting to sequential patients with varying diagnoses. Tobacco use, household exposure to tobacco, and interest and preferences for smoking cessation treatment were recorded. Descriptive statistics and Pearson's chi-squared test were used for analysis. RESULTS Of the 599 surveys administered, 594 (99%) were completed. Self-reported smoking status included 36.4% (n=218) never smokers, 53.3% (n=319) former smokers, and 10.4% (n=62) current smokers. Among current smokers, 45.2% (n=28) were interested in receiving smoking cessation treatment. Preferences for treatment included: 21.4% (n=6) who wanted Quitline only, 25% (n=7) medication alone, and 53.6% (n=15) combined Quitline plus medication. Current smokers (55.7%, n=34) were more likely to live in households with tobacco exposure compared to those with former (11.4%, n=36) or never smokers (8.3%, n=18) (p<0.0001). CONCLUSIONS Implementing a computer-facilitated system to screen for current smoking and provide smoking cessation services was feasible in the outpatient thoracic surgery and oncology setting. Almost half of the smokers indicated an interest in receipt of smoking cessation treatment. Household exposure was more frequent among current smokers, therefore routine screening for secondhand smoke exposure from other household members is an important consideration in developing smoking cessation treatment plans to mitigate health risks among vulnerable patient populations. [ABSTRACT FROM AUTHOR]

Introduction. Clinical effort against secondhand smoke exposure (CEASE) is an evidence-based intervention that prepares child healthcare clinicians and staff with the knowledge, skills, and resources needed to ask family members about tobacco use, provide brief counseling and medication assistance, and refer to free cessation services. Aim. This study sought to identify factors that influenced the implementation of CEASE in five pediatric intervention practices in five states that participated in a cluster randomized clinical trial of the CEASE intervention. Methods. Guided by questions from the consolidated framework for implementation research (CFIR) interview guide, semistructured qualitative interviews were conducted with 11 clinicians and practice staff from five intervention practices after the practices had implemented CEASE for two years. Interviews were conducted by a trained qualitative researcher, recorded with permission, and transcribed verbatim. An interview codebook was inductively developed; two researchers used the codebook to code data. After coding, data was analyzed to identify factors, as described by the CFIR domains that influenced the implementation of CEASE. Results. The implementation of CEASE in practices was influenced by the adaptability and complexity of the intervention, the needs of patients and their families, the resources available to practices to support the implementation of CEASE, other competing priorities at the practices, the cultures of practices, and clinicians' and office staffs' knowledge and beliefs about family-centered tobacco control. Conclusion. Identifying and influencing certain critical factors guided by information gathered through interviews may help improve implementation and sustainability of family-centered tobacco control interventions in the future. Trial Registration: ClinicalTrials.gov Identifier: NCT01882348. [ABSTRACT FROM AUTHOR]