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INTRODUCTION E-cigarette use is most prevalent among adolescents and young adults - and there are often misperceptions about product risk. The purpose of this study was to determine what nicotine information is provided on e-cigarette brand websites. METHODS Based on national and local surveys, we identified 44 e-cigarette brands commonly used in the US by adolescents and young adults. For each of these brands, their associated websites were analyzed for disclosed nicotine information. Specifically, for each brand's website, we coded whether there was information on nicotine concentration (recorded if a numerical value was provided such as '5% nicotine'), nicotine form (free-base, nicotine salts, or not stated), and nicotine type (tobacco-derived, synthetically derived, or not stated). Coding allowed for both lay (e.g. 'nic salts') as well as scientific (e.g. 'isomers') terms. RESULTS Of the 44 brands examined, all provided basic information on nicotine concentration (e.g. '5% nicotine'). However, 23% of brands did not disclose information on nicotine form (i.e. nicotine salt vs free-base), and 66% of brands did not disclose information on nicotine type (i.e. synthetic vs tobacco-derived). CONCLUSIONS Overall, these results suggest that the e-cigarette industry is not fully informing its consumers about the nicotine in their products. Given that nicotine form and type have implications for e-cigarette addiction potential, these findings highlight a public health concern. There is a need for more comprehensive national regulations for mandating product constituents and emissions disclosures. [ABSTRACT FROM AUTHOR]

Objectives: Nationwide implementation of Tobacco 21 (raising the legal sales age for all tobacco products to 21) is occurring against the backdrop of an electronic cigarette (e-cigarette) epidemic among young people, which makes Tobacco 21 evaluation difficult. To address this issue, we examined young adult use of e-cigarettes separately from use of other tobacco products. Our objective was to determine whether use changed after Tobacco 21 implementation and whether those changes differed by product. Methods: In Columbus, Ohio, which began enforcing Tobacco 21 in 2017, we surveyed incoming first-year undergraduates at a large, public university in 2016 (Cohort 1; n = 529) and re-contacted them in 2018. We surveyed a new sample of incoming first-year students in 2018 (Cohort 2; n = 611). Survey items assessed tobacco use, sources for obtaining tobacco, and attitudes surrounding Tobacco 21. Results: Both cross-sectional (Cohort 1 vs Cohort 2) and prospective (pre–post Tobacco 21 in Cohort 1) analyses indicated a slight decline in most tobacco use from 2016 to 2018, but e-cigarette use more than doubled during the same period. Students enrolled throughout the transition to Tobacco 21 (Cohort 1) perceived little effect of Tobacco 21 on peer use. The largest proportions (35.3%-43.5%) of combustible tobacco were obtained outside Columbus; 61.8% of e-cigarette users reported obtaining e-cigarettes through borrowing. Conclusions: Tobacco 21 was associated with reductions in combustible and smokeless tobacco use, but its impact was not sufficient to curb the surge in e-cigarette use. Tobacco 21 should be contextualized as part of a broader network of tobacco control efforts, including additional youth-access regulations, that may be needed to address e-cigarette use among young people. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare prevalence of JUUL use and JUUL risk perceptions between adolescents living in an urban area versus Appalachian areas of the U.S. Data were drawn from a prospective cohort study of adolescent males (the Buckeye Teen Health Study, or BTHS); our cross-sectional analysis used data from one timepoint, collected between January and December 2019 (N = 873). Chi-square tests and multivariable logistic regression compared JUUL use prevalence and risk perceptions between participants in an urban Ohio county and nine predominantly rural Appalachian Ohio counties. Over a quarter of the sample (29.2%) had ever used JUUL. In the unadjusted model, prevalence of JUUL use was similar between regions but Appalachian participants perceived JUUL as more harmful (p <.001) and more addictive (p =.04) than urban participants. In the adjusted model, region was not significantly related to current JUUL use (OR: 1.20, 95% CI: 0.77, 1.87) or ever JUUL use (OR: 1.15, 95% CI: 0.83, 1.60). JUUL use was similar between urban and Appalachian participants despite regional differences in risk perceptions. Interventions that only target risk perceptions may not be sufficient to prevent adolescent e-cigarette use, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Emerging data indicate that many adolescents and young adults ("youth") engage in infrequent, or occasional, e-cigarette use. However, little is known about this population as they are often subsumed into the broader "any past-30-day use" category used to define youth "current use." This study aimed to focus on infrequent e-cigarette use by youth, examining its correlates and transitional outcomes. Participants were from a prospective cohort study of youth (aged 15–24 at baseline). Among youth who had used e-cigarettes, we classified "infrequent use" as using e-cigarettes ≤5 days in the last 30 days (n=273) and "frequent use" as using e-cigarettes ≥6 days in the last 30 days (n=278). Descriptive statistics, Markov modeling, and logistic regression were utilized. By the 12-month follow-up, 76.8% of those using infrequently at baseline remained in the "infrequent use" category, 6.3% reported no recent use, and 16.8% had escalated to the "frequent use" category. Among the youth using infrequently at baseline, those who did (vs. did not) escalate to frequent use by follow-up had higher baseline nicotine dependence and were more likely to have family members who used tobacco. Infrequent e-cigarette use is extremely common, and often fairly stable, among young people. Prevention efforts must certainly attempt to reduce escalation and attend to both individual and interpersonal factors (e.g., nicotine dependence, family use). Yet prevention efforts must additionally attend to the case of continued infrequent use, given the high prevalence of people in this category and their regular exposure to e-cigarette harms. • Many young people use e-cigarettes infrequently (≤5 days in the last 30 days). • This is one of the first studies to focus on youth who vape infrequently. • Some youth (16.8%) escalated from infrequent to frequent use over a 12-month period. • But most youth (76.8%) maintained infrequent e-cigarette use over 12 months. • Youth who vape infrequently merit greater attention in research and practice. [ABSTRACT FROM AUTHOR]

Examine trends in e-cigarette use, and Juul use specifically, among U.S. college students. In 2016, we established a cohort of 529 incoming first-year students to a large Midwestern University. In 2018, these students (now third-years) were re-contacted, and a new sample of 611 incoming first-year students was enrolled. First-year students in 2016 completed a survey assessing their e-cigarette use; in 2018, first- and second-year students reported on e-cigarette use, and use of Juul specifically. From 2016 to 2018, past 30-day e-cigarette use rose from 5.9% to 27.7%. In 2018, for Juul alone, ever use was above 35% and past 30-day use was above 20% for both cohorts. Juul use did not differ by gender, but was associated with higher socioeconomic status (SES) and being White. Findings present disturbing possibilities for long-term nicotine addiction among the next generation, and underscore the need for a rapid public health response. [ABSTRACT FROM AUTHOR]

Objectives: E-cigarettes are now the most commonly-used tobacco product among adolescents; yet, little work has examined how the appealing food and flavor cues used in their marketing might attract adolescents' attention, thereby increasing willingness to try these products. In the present study, we tested whether advertisements for fruit/sweet/savory-flavored ("flavored") e-cigarettes attracted adolescent attention in real-world scenes more than tobacco flavored ("unflavored") e-cigarettes. Additionally, we examined the relationship between adolescent attentional bias and willingness to try flavored e-cigarettes. Methods: Participants were 46 adolescents (age range: 16-18 years). All participants took part in an eye-tracking paradigm that examined attentional bias to flavored and unflavored e-cigarette advertisements embedded in pictures of real-world storefront scenes. Afterwards, participants' willingness to try flavored and unflavored e-cigarettes was assessed. Results: In support of our primary hypothesis, adolescents looked longer and fixated more frequently on flavored (vs unflavored) e-cigarette advertisements. Moreover, this attentional bias towards flavored e-cigarette advertisements predicted a greater willingness to try flavored vs unflavored e-cigarettes. Conclusions: These findings suggest that flavored e-cigarette marketing attracts the attention of adolescents, increases their willingness to try flavored e-cigarette products, and could, therefore, put them at greater risk for tobacco initiation. [ABSTRACT FROM AUTHOR]

Background: Previous studies have examined what adolescents find appealing in tobacco and alcohol advertisements and how different themes in advertisements are used to manipulate consumer behaviors. Yet, we know little about the relationship between the themes portrayed in advertisements and youth attitudes towards those themes. Objectives: This study compared attitudes towards advertisements for different consumer products in a sample of urban and rural adolescent boys in order to examine how key marketing themes impact adolescent attitudes towards those advertisements. Methods: Participants were 11- to 16-year-old boys (N = 1220) residing in either urban or rural Ohio Appalachian counties. Each participant viewed five print advertisements (one each for cigarettes, electronic cigarettes (e-cigarettes), smokeless tobacco (SLT), non-alcoholic beverages, and alcohol), presented in a random order, for eight seconds each. All advertisements had appeared in magazines that adolescent males commonly read. Attitudes towards each of the five advertisements were assessed. The advertisements were then coded for the presence of various themes, including social acceptance and masculinity. Analyses were conducted to determine associations between advertisement type and the attitude measure, and between the presence of a theme and the attitude measure. Results: Overall, participants preferred non-tobacco advertisements to tobacco advertisements, rural participants had less positive attitudes and participants who had peers who used tobacco had more positive attitudes. Social acceptance and entertainment themes increased the appeal of SLT advertisements, and sex appeal increased the appeal of e-cigarette advertisements. Conclusions/Importance: Findings suggest that advertisements that promote the social nature of use in SLT advertisements may be of particular concern for their influence on adolescent boys. [ABSTRACT FROM AUTHOR]

Objectives: In the United States, print advertisements for smokeless tobacco (SLT) feature a large warning covering 20% of the advertisement space, whereas cigarette and e-cigarette advertisements cover approximately 4%. We explored how warning size affects adolescent boys' recollection of the warning, brand-relevant advertisement features, and product risks. Methods: Overall, 1220 adolescent males (ages 11-16) viewed SLT, cigarette, and e-cigarette advertisements and were asked to recall what they remembered most. Coders identified recalls of the warning label, advertisement features, and risks associated with the product in responses. Results: Participants were less likely to recall warnings in the cigarette versus SLT (OR = 0.30, p < .001) and e-cigarette versus SLT (OR = 0.15, p < .001) ads. Separate GEEs revealed that boys who recalled warnings were less likely to mention brand-relevant advertisement features (OR's < 0.32, ps < .001). Logistic regressions revealed that boys who recalled the warnings were more likely to mention risks associated with the products (ORs > 3.50, ps < .001). Conclusions: Adolescent boys are more likely to recall large SLT warnings than small cigarette and e-cigarette warnings. Warning recall is associated with lower likelihood of recalling brand-relevant advertisement features and greater likelihood of mentioning product risks. [ABSTRACT FROM AUTHOR]

Background: Married couples often share similar health-related characteristics and behaviors, including cigarette smoking status. Despite their rising popularity in the U.S., little research has examined the patterns of spousal concordance (SC) for alternative tobacco products (ATPs), such as e-cigarettes, cigars, and hookah.Methods: The purpose of this project was to examine the roles of age, gender, and culture in the strength of SC for these ATPs. Analyses focused on a diverse community sample of married individuals in Ohio, U.S. (N=278), but also examined patterns in Austria, Greece, Israel, the Netherlands, and Slovakia. All participants completed a survey in which they indicated both their own, and their spouse's ever-use of various tobacco products.Results: For the U.S. sample, SC was highest for e-cigarettes, flavored e-cigarettes, flavored cigarettes, and hookah (ϕs=0.48- 0.61); SC appeared to be stronger among younger couples, and when there was only a small female vs. male differences in use. Similar patterns were found in the other countries, with a few key exceptions. In particular, there was low SC for e-cigarettes and flavored e-cigarettes in the other countries, where e-cigarettes had been federally regulated by the time of data collection.Conclusion: Overall, these findings have implications for the continued spreading popularity of these tobacco use behaviors. [ABSTRACT FROM AUTHOR]

Objectives. To conduct a content analysis of news articles to investigate the relationship between language used to describe e-cigarettes, how the news articles framed (conveyed information to influence a certain perception of the news read by its audience) e-cigarettes, and the Food and Drug Administration's (FDA's) oversight of e-cigarettes. Methods. We searched a database of articles published across the United States from February 1, 2016, to February 28, 2017, using the headline terms "e-cigarette," "e-cig," and "vape." We then dichotomized terms into 2 categories: technical ("e-cigarette" or "e-cig") and nontechnical ("vape"). We coded the frame of each article body as positive, negative, or neutral or mixed. Results. Articles containing the term "vape" in the headline were more likely to positively frame e-cigarettes (P ≤.001) and negatively frame FDA oversight (P ≤.001) in the body than were those with "e-cigarette" or "e-cig" in the headline. Conclusions. Omitting the word "cigarette" when describing tobacco products may reduce the negative perception associated with tobacco use, making it more appealing. It is important to know which terms are used to describe e-cigarettes and how these terms can make those products appear less harmful. [ABSTRACT FROM AUTHOR]

Considerable research has examined how cigarette point-of-sale advertising is closely related to smoking-related disparities across communities. Yet few studies have examined marketing of alternative tobacco products (e.g., e-cigarettes). The goal of the present study was to examine external point-of-sale marketing of various tobacco products and determine its association with community-level demographics (population density, economic-disadvantage, race/ethnicity) in urban and rural regions of Ohio. During the summer of 2014, fieldworkers collected comprehensive tobacco marketing data from 199 stores in Ohio (99 in Appalachia, 100 in Columbus), including information on external features. The address of each store was geocoded to its census tract, providing information about the community in which the store was located. Results indicated that promotions for e-cigarettes and advertising for menthol cigarettes, cigarillos, and cigars were more prevalent in communities with a higher percentage of African Americans. Cigarillos advertising was more likely in high-disadvantage and urban communities. A greater variety of products were also advertised outside retailers in urban, high-disadvantage, African American communities. Findings provide evidence of differential tobacco marketing at the external point-of-sale, which disproportionately targets urban, economically-disadvantaged, and African American communities. There is a need for tobacco control policies that will help improve equity and reduce health disparities. [ABSTRACT FROM AUTHOR]

Aims Design, setting, participants Measurements Findings Conclusions To measure nicotine delivery, vaping topography and subjective effects of current generations of disposable, cartridge‐based and other types of electronic cigarettes (e‐cigarettes) among young adults.Observational, human laboratory assessment of e‐cigarette use in Columbus, Ohio, USA (July 2020 to June 2021). Participants (n = 96, 60.4% female, age mean = 21.7 [standard deviation = 1.7] years, 82.4% white race) were identified via their participation in a cohort study or other convenience sampling and were 18 to 25 years old, vaped ≥4 days/week for ≥4 weeks and used other tobacco products for ≤5 days of past 30 days. Participants completed a pre‐vaping questionnaire, vaped their usual brand of e‐cigarette ad libitum for 30 min and completed a post‐vaping questionnaire.Outcome variables included pre‐ and post‐vaping measures of plasma nicotine (t = 0 and t = 30, respectively) and craving and withdrawal symptoms, as well as vaping topography (e.g. flow rate and inter‐puff interval), pre‐vaping expectancies and post‐vaping product appeal. Variables used to characterize the sample included demographics, e‐cigarette and other tobacco use history, e‐cigarette dependence and e‐cigarette device characteristics (e.g. device type, flavor and nicotine form).Participants reported moderate nicotine dependence on average via the E‐Cigarette Dependence Scale (mean = 6.9 [standard deviation = 4.0]). Following 30 min of ad libitum vaping, participants achieved substantial plasma nicotine boost (mean = 18.8 [standard deviation = 14.5] ng/mL), corresponding with statistically significant decreases in withdrawal symptoms measured via the Minnesota Nicotine Withdrawal Scale (pre‐vaping mean = 9.0 [standard deviation = 5.1], post‐vaping mean = 4.3 [standard deviation = 3.9]; P‐value <0.0001). Pre‐vaping, participants reported moderate vaping expectancies (e.g. mean = 2.5 [standard deviation = 1.0] on a scale from 0 to 4 for smell and taste expectancies); post‐vaping, participants reported high satisfaction (mean = 4.6 [standard deviation = 1.2] on a scale from 1 to 7) and moderate reward (mean = 2.9 [standard deviation = 1.2]) and respiratory sensations (mean = 3.7 [standard deviation = 1.6]). Nearly half of participants (47.9%) used disposable e‐cigarettes, and most used a mint/menthol or fruit flavored (99.0%) and nicotine salt (98.9%) e‐liquid.Among young adults in the United States, the latest generations of e‐cigarettes appear to deliver large quantities of nicotine (similar to cigarettes) and significantly relieve withdrawal symptoms, and they are appealing. [ABSTRACT FROM AUTHOR]

Introduction: Understanding patterns of single and multiple tobacco product use among reproductive-aged women is critical given the potential for adverse health effects on mother and infant should a woman become pregnant.Methods: Patterns of tobacco use over a 2-year period were examined among all women (18-44 years) who completed wave 1 (W1) and wave 2 (W2) of the US Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) Study. We examined the most common patterns of single and multiple tobacco product use in W1, and longitudinal trajectories of women engaged in each of these patterns of use from W1 to W2, among women not pregnant in either wave (n = 7480), not pregnant in W1 and pregnant in W2 (n = 332), and pregnant in W1 and not pregnant in W2 (n = 325).Results: The most prevalent patterns of tobacco use in W1 among all three subgroups were using cigarettes alone followed by using cigarettes plus e-cigarettes. In all three subgroups, women using multiple products in W1 were more likely to adopt new use patterns in W2 relative to single-product users, with the new patterns generally involving dropping rather than adding products. The majority of multiple product use included cigarettes, and transitions to single product use typically involved dropping the noncigarette product. The most common trajectory among tobacco users transitioning to or from pregnancy was to use cigarettes alone in W2.Discussion: This study contributes new knowledge characterizing tobacco use patterns across time and reproductive events among reproductive-aged women. [ABSTRACT FROM AUTHOR]

Introduction: Electronic cigarette (e-cigarette) use among adolescents is associated with increased risk of subsequent cigarette smoking initiation in observational research. However, the existing research was not designed to answer causal questions about whether adolescent e-cigarette users would have initiated cigarette smoking if they had never used e-cigarettes. The current study used a causal inference framework to identify whether male adolescent e-cigarette users were at increased risk of initiating cigarette smoking and smokeless tobacco (SLT) use, compared to similar boys who had never used e-cigarettes.Methods: Boys from urban and Appalachian Ohio (N = 1220; ages 11-16 years at enrollment) reported use of e-cigarettes, cigarettes, and SLT at baseline and every six months for two years. A propensity score matching design was implemented, matching one e-cigarette user to two similar e-cigarette non-users. This analysis was completed in 25 multiple imputed datasets to account for missing data. Risk ratios (RRs) comparing risk of initiating cigarettes and SLT for e-cigarette users and nonusers were estimated.Results: Compared to non-users, e-cigarette users were more than twice as likely to later initiate both cigarette smoking (RR = 2.71; 95% CI: 1.89, 3.87) and SLT (RR = 2.42; 95% CI: 1.73, 3.38). They were also more likely to become current (i.e., past 30-day) cigarette smokers (RR = 2.20; 95% CI: 1.33, 3.64) and SLT users (RR = 1.64; 95% CI: 1.01, 2.64).Conclusions: Adolescent boys who used e-cigarettes had increased risk of later initiating traditional tobacco products when compared to similar boys who had never used e-cigarettes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Researchers in several studies have examined correlations between tobacco harm perceptions and tobacco use in youth, but none have prospectively addressed the association between harm perceptions and subsequent new use across multiple noncigarette products. METHODS: Product-specific absolute and relative harm perceptions for cigarettes, electronic cigarettes (e-cigarettes), cigars, pipes, hookah, and smokeless tobacco were collected at wave 1 (W1) (2013-2014) among youth in the nationally representative US Population Assessment of Tobacco and Health Study (12-17 years of age; n = 10 081). At wave 2 (W2) (2014-2015), product-specific new use was calculated. Adjusted relative risks were used to estimate if harm perceptions at W1 predicted W2 new tobacco use. RESULTS: The proportion of youth who endorsed "a lot of harm" was highest for cigarettes (84.8%) and lowest for e-cigarettes (26.6%); the proportion of youth who thought products were "more harmful" than cigarettes was highest for cigars (30.6%) and lowest for e-cigarettes (5.1%). Among youth who had not used those products at W1, product-specific new use at W2 ranged from 9.1% (e-cigarettes) to 0.6% (pipes). Youth who believed that noncombustible tobacco products posed "no or little harm" at W1 were more likely to have tried those products at W2 (P < .05). Youth who viewed e-cigarettes, hookah, and smokeless tobacco as "less harmful" than cigarettes at W1 were more likely to try those tobacco products at W2 (P < .05). CONCLUSIONS: Low harm perceptions of noncigarette tobacco products predict new use of these products by youth within the next year. Targeting product-specific harm perceptions may prevent new tobacco use among youth. [ABSTRACT FROM AUTHOR]

This study examined quit rates longitudinally for cigarettes, e-cigarettes, hookah, cigars, and all tobacco products in a U.S. national sample of women aged 18-44 who completed both Wave 1 (W1) and Wave 2 (W2) of the Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) study (N = 7814). Quit rates were examined among women who transitioned into pregnancy across survey waves, and among a comparable sample of non-pregnant women to provide contextual information about quitting among the broader population of reproductive-aged women. Multiple logistic regression modeling was used to estimate the associations of pregnancy and quitting adjusting for other demographic and psychosocial characteristics. Quit rates among women who were pregnant in W2 were highest for hookah (98.3%), followed by cigars (88.0%), e-cigarettes (81.3%), and lowest for tobacco cigarettes (53.4%). Slightly more than half (58.7%) of women reported quitting use all tobacco products while pregnant. Pregnancy was independently associated with increased odds of quitting hookah (AOR = 52.9, 95%CI = 3.4, 830.2), e-cigarettes (AOR = 21.0, 95%CI = 2.6, 170.3), all tobacco products (AOR = 9.6, 95%CI = 6.4, 14.5), and cigarettes (AOR = 6.5, 95%CI = 4.2, 10.1), although not cigars. Relative to other demographic and psychosocial characteristics, pregnancy was the strongest predictor of quitting use of each tobacco product. While these data indicate that pregnancy has strong, independent associations with quitting a variety of commercially available tobacco products, the comparatively lower quit rates for cigarettes versus other tobacco products underscores the long-standing need for more intensive, multipronged clinical and regulatory interventions to reduce cigarette use among reproductive-aged women. [ABSTRACT FROM AUTHOR]

Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women. [ABSTRACT FROM AUTHOR]