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Introduction: There has been rising concern about e-cigarette usage among teenagers and young adults. As knowledge about the adverse health effects of e-cigarettes accumulates, it is critical to identify factors that may increase risk of vaping initiation and frequency of use. One potential risk factor known to increase risk for other substance use is impulsivity. This study tested the hypothesis that impulsivity prospectively predicts vaping over time. Methods: Active e-cigarette users (n = 137; 51.8% male; Mean age 20 years at baseline) completed 8 waves of assessment over 21 months (2017-2020). The S-UPPS-P impulse behavior scale was used at baseline to measure impulsivity, and frequency of e-cigarette, cigarette, marijuana and alcohol use was calculated at each wave thereafter. Results: Vaping frequency declined over time [Incidence Rate Ratio (IRR) = 0.92]. There were significant, stable, positive associations between e-cigarette use and lack of premeditation (IRR = 1.06) and sensation seeking (IRR = 1.09). Vaping frequency was inversely associated with negative urgency (IRR = 0.95). Positive urgency and lack of perseverance were not associated with frequency of vaping. Conclusion: These findings suggest that young adults who have higher impulsivity of certain types may use e-cigarettes more frequently. Thus, vaping interventions for young adults should address these factors to ensure the greatest impact on public health.

IntroductionIncreasing marijuana use among young adults is a concern due to substantial acute and chronic health risks. More widespread use of marijuana may also lead to increased use of nicotine and tobacco products. California legalized commercial sales of marijuana for recreational use as of January 2018. To our knowledge no studies to date have examined subsequent changes in marijuana use. The goal of this study was to test the hypothesis that marijuana use frequency increased following legalization of recreational sales. We also hypothesized that increased marijuana frequency would predict greater frequency of nicotine/tobacco consumption.MethodsThe study was a secondary analysis of a longitudinal study of tobacco use among non-daily cigarette smokers. Participants were 563 young adults (aged 18-24) enrolled in 2015-16 and followed quarterly for 3 years.ResultsA piecewise multilevel regression model indicated that marijuana use frequency did not change over time, including following legalization. More frequent use was associated with younger age and identifying as white (ps

ObjectiveTo evaluate the efficacy of a brief telephone-delivered Motivational Interviewing (MI)-based intervention to facilitate engagement in evidence-based cessation treatment for Veterans with mental illness referred to smoking cessation treatment.Methods86 military Veteran smokers with mental illness were recruited from a tobacco cessation consult clinic and randomized to receive either a MI-based treatment engagement intervention (TE; n = 48) or a non-MI assessment and information control (CON; n = 38) condition. Intervention was delivered during a single brief telephone contact. Primary engagement outcomes were 1) attending a treatment session within 30 days and 2) combination treatment (attending session plus using pharmacotherapy). Cessation outcomes included self-reported 24 h cessation attempts and 7 day point abstinence at 3 months post-intervention. Outcomes were assessed at 1 and 3 months post intervention.ResultsOutcome analyses included 85 participants (47 TE, 38 CON) using an intent-to-treat analytic approach. Participants were on average 49.5 (13.4) years old, 88% Male, 59% white, 18% African American and 14% Hispanic/Latino(a). Following intervention delivery TE and CON participants did not differ on likelihood of attending a treatment session during the subsequent 30 days (47% vs 45%, respectively). A significant difference was observed when classified as utilizing combination treatment, 40% of TE versus 18% of CON reported use of smoking cessation medication and behavioral counseling (p = 0.04). No statistical differences were observed for cessation outcomes, although more TE than CON participants reported 7 day point abstinence at 3 months post-intervention (30% vs 18%).ConclusionsThe present pilot study provides initial evidence for the feasibility, acceptability and efficacy of a telephone delivered TE intervention for enhancing engagement in combinationevidence evidence-based treatment in a sample of Veteran smokers with mental illness referred to smoking cessation treatment. Smokers with mental illness typically have greater difficulty stopping smoking than those without mental illness. Increased engagement in combination treatment thus has the potential to increase quit rates and ultimately reduce the burden of tobacco use for this population.

BackgroundThe risks of polytobacco use among young adults are unclear because we know relatively little about the consistency of multiproduct patterns over time and how these patterns impact cigarette smoking. The purpose of this study was to examine changes in multiple tobacco product use over time and associations with cigarette smoking quantity.MethodsParticipants (n=335; 55% male) were 18-24 years old non-daily cigarette smokers living in California. Polytobacco use patterns were assessed quarterly for 2 years.ResultsTransition analyses showed that while the number of products that had been used recently was volatile, the most common pattern was stability between timepoints. A longitudinal negative binomial regression model indicated that those who used more non-cigarette products also reported greater cigarette quantity. The strength of this relationship increased over time.ConclusionsFindings suggest that individuals who use more tobacco products are at greater risk for increased cigarette smoking and maintaining a multiple product use pattern.

Recent data regarding growth in concurrent use of nicotine and marijuana have raised concern that reductions in legal restrictions on marijuana use may increase risk for tobacco-related harms. Previous studies have shown cross-sectional links between use of both substances, but less is known about associations over time. The goal of the present study was to test the hypothesis that there is a bidirectional relationship between use of marijuana and use of tobacco products over time, such that increasing use of either substance would predict increasing use of the other. Participants (n = 391, 52% male) were 18-24 year-old Californians who were non-daily cigarette smokers at enrollment and had never been daily smokers. They reported nicotine/tobacco and marijuana use quarterly over 2 years. Longitudinal negative binomial and logistic regression models indicated that each additional timepoint at which participants reported recent marijuana use predicted 9-11% increases in tobacco quantity and frequency. Additionally, each additional timepoint at which cigarette or tobacco use was reported predicted 19-22% greater marijuana frequency. Data suggest that young adults who use marijuana more frequently are likely at risk for greater tobacco exposure, and vice versa. These findings suggest a need for preventive measures that focus on concurrent use of both substances rather than either individually.

BackgroundWith an increase in marijuana use among adults in the United States (US), understanding the potential impact of marijuana use on tobacco use and associated behavioral and health consequences, including respiratory conditions, is necessary.MethodSurvey responses from Wave 1 of the nationally representative Population Assessment of Tobacco and Health (PATH) Study were used to assess tobacco use and marijuana use among non-current tobacco users (n = 17,952) and current established tobacco-users classified as: cigarette only users (n = 8689), e-cigarette only users (n = 437), cigar only (traditional, cigarillo, or filtered) users (n = 706), hookah only users (n = 461), smokeless tobacco only users (n = 971), cigarette + e-cigarette users (n = 709), and users of multiple tobacco products (n = 2314).ResultsWhen compared to non-current tobacco users, each tobacco user group except smokeless only users had higher odds (odds ratios ranging from 3.86-8.07) of reporting current marijuana use. Among current tobacco users, higher levels of tobacco dependence did not explain the relationship between tobacco use and marijuana use. Additionally, concurrent marijuana use was associated with lower odds of attempts to quit tobacco (OR = 0.86, 95% CI = 0.79, 0.94, p

Increasing access to and utilization of alcohol use services for ethnically diverse adolescents remains an important public health concern. This study examined whether a voluntary, school-based, developmentally-tailored alcohol use intervention (i.e., Project Options) engaged and retained ethnically diverse participants across three cities. The role of group and school diversity characteristics (i.e., ethnic diversity, ethnic congruence of individual and context) in engagement and retention was explored. A total of 596 participants across six schools were included in analyses. Overall, the intervention engaged and retained ethnically diverse participants consistent with each school context (79.7% returned for additional sessions). Mixed-effects logistic models demonstrated that Black/African American participants were more likely to return to the intervention compared to Non-Hispanic White, Asian/Pacific Islander, and Hispanic participants. Group and school diversity characteristics did not impact participants’ return to the intervention. Findings provide initial evidence that Project Options is adaptable to the sociocultural context of different implementation sites.

IntroductionCigarette smoking remains a significant health risk for Veterans. Increased understanding of factors that influence the tobacco cessation referral process within Veterans Affairs medical facilities is useful for enhancing utilization of smoking cessation treatment. The present study examined the association of demographic and health variables with whether smokers accepted referral for medication and/or tobacco cessation clinic.MethodsElectronic medical record data (2011-2013) were obtained for a sample of US military Veterans who accepted cessation assistance from their health care provider. Demographic and diagnostic variables were examined to identify predictors of the types of assistance accepted (medication only, clinic referral only, or both).ResultsThe sample includes 2941 Veterans, 10.3% female, 19.9% African American, 10.7% Hispanic, and 57.9% non-Hispanic white. Veterans averaged of 50.69 years of age (SD = 14.01), 31.5% had a substance use disorder diagnosis and 54.1% had a psychiatric diagnosis. Demographic and diagnostic information was compared across types of assistance accepted. Significant differences were found between those who accepted medications only and those who accepted either clinic referral or both medication and clinic referral. Veterans in the latter two categories were younger and more likely to have a psychiatric diagnosis than those accepting medication only. Women Veterans were significantly more likely than men to accept clinic referral plus medication. However, in contrast to men, almost none of the variables examined were associated with the type of assistance accepted by women.ConclusionThese findings indicate significant gender differences in influences on accepting assistance for smoking cessation among Veterans.ImplicationsExisting research identifies factors associated with unassisted quitting. However, little is known regarding the referral process, which is critical in connecting smokers with treatment. The present work is unique in employing electronic medical record data to examine factors associated with accepting different types of smoking cessation treatment referrals. This study represents an initial effort to elucidate the smoking cessation treatment referral process. These findings highlight the need to examine sex specific influences on smoking cessation treatment utilization and the importance of focusing on smokers with psychiatric disorders.

BackgroundTobacco smoking and related health problems are still major public health concerns in the United States despite the declining smoking prevalence.ObjectivesThis study explored differences in smoking prevalence between urban and rural areas potentially relevant to tobacco control efforts in California.MethodsPublic use adult smoking data from the California Health Interview Survey (CHIS) between 2001 and 2011-2012 were analyzed. A total of 282 931 adults were surveyed across the six CHIS cycles. A ZIP code-based geographic classification (Urban, Second-City, Suburban, and Town/Rural) was used to examine the association between smoking prevalence and area of residency.ResultsThe overall smoking prevalence in California decreased from 17.0% in 2001 to 13.8% in 2011-2012. Within each CHIS cycle, the Town/Rural areas had the highest smoking prevalence, followed by Urban and Second-City areas, and Suburban areas had the lowest. Pooled data from all CHIS cycles showed a similar pattern, with rates in Urban, Second-City, Suburban and Town/Rural areas being 15.2%, 15.2%, 13.1% and 17.3%, respectively. Weighted multivariate logistic regression analysis indicated significantly higher odds of smoking in Urban, Second-City and Town/Rural areas compared to Suburban areas (all adjusted odds ratios > 1.10), although this trend varied by race/ethnicity, being present in non-Hispanic Whites and not present in Hispanics.ConclusionsTown/Rural and Urban populations of California are consistently at higher risk of smoking than Suburban populations. These results indicate a need for population-specific tobacco control approaches that address the lifestyle, behavior, and education of disparate populations within the same state or region.

Limited research has explored the role of in-session behavior during motivational enhancement (ME) in group formats. The current study presents initial feasibility of assessing behavior of high school students (N = 425) attending Project Options, a voluntary secondary drug and alcohol prevention program utilizing ME techniques. Building on previous research exploring client language supporting/opposing health behavior, student group behavior was coded live at the specific utterance and global level; group leader behavior was also coded globally. Interrater reliability of the coding system was assessed, and preliminary validity of the coding system was examined by exploring associations between characteristics of group members and in-session group behavior. Initial reliability estimates were excellent for the specific behavior codes. Reliability of the global codes was mixed, with raters demonstrating good reliability on support for unhealthy behavior, opposition to unhealthy behavior, and support for healthy behavior. Reliability of the group leader codes was fair to poor. Greater percent healthy talk was associated with a lower percentage of group members reporting lifetime alcohol use. The results of the current study suggest that some in-session behavior at the group level can be coded reliably via live observation and that in-session behavior at the group level is associated with alcohol use prior to attending the program. Future research is needed to explore the utility of in-session behavior in terms of predicting future behavior at the group and individual level.

IntroductionHookah use is increasingly common among U.S. college students, but little is known regarding the relationship between hookah and cigarette use. The purpose of this study was to test the hypothesis that the added nicotine exposure from hookah use may accelerate the uptake of cigarettes.MethodsAn ethnically diverse sample of college students (n = 256; 43% female) who had smoked cigarettes in the past month completed 2 in-person interviews over 6 months. This study was a secondary analysis of data collected for a longitudinal study of young adult cigarette smoking patterns. Analyses examined 6-month changes in past 30 day cigarettes smoked and number of days smoking, controlling for age, nicotine dependence, marijuana use, and the respective baseline variable for each outcome.ResultsCurrent hookah use (any use in past 30 days) was endorsed by 34% of participants at baseline, while 94% reported lifetime use. Change in past 30 day number of cigarettes (p = .043) and number of smoking days (p = .040) differed significantly between those who did or did not report recent hookah use at baseline. Hookah users reported a greater number of cigarettes smoked at the 6-month follow-up, while nonusers decreased their smoking quantity. For number of smoking days in the past 30, hookah users reported a smaller decrease than nonusers.ConclusionsRecent hookah use predicted increased cigarette smoking over 6 months in a college sample. These are the first prospective data demonstrating this relationship, indicating the value of developing strategies to prevent hookah use among college students.

BackgroundA growing literature addresses the need to reduce cigarette smoking prevalence by increasing the use of assistance when quitting. A key focus is to identify strategies for enhancing adoption of effective interventions in order to increase utilization of evidence-based treatments.PurposeTo examine the effect of beliefs regarding ability to quit on utilization of assistance for smoking cessation. A mediation model was hypothesized whereby the relationship between smoking and use of assistance is influenced by beliefs in ability to quit.MethodsThe present study includes 474 of 1000 respondents to baseline and follow-up California Smokers Cohort surveys conducted from 2011 to 2013. Included were baseline smokers who reported a 24-h quit attempt at follow-up. Baseline variables were used to predict use of assistance when quitting.ResultsThe hypothesized model was tested using a product of coefficients method, controlling for demographics. Greater heaviness of smoking and lower belief in ability to quit were significantly related to use of assistance. Quitting beliefs significantly mediated the relationship between nicotine dependence and use of assistance.ConclusionsThe present data support a mechanism whereby the effect of smoking rate on treatment utilization is mediated by beliefs in ability to quit. Greater belief in one's ability to quit may represent an obstacle to treatment utilization by reducing the likelihood of successful cessation. The present findings suggest the value of targeted messages from health care providers that normalize the need for assistance when attempting to change an addictive behavior and emphasize the difficulty of quitting without assistance.

ObjectivesWe assessed whether an anti-tobacco television advertisement called "Stages," which depicted a woman giving a brief emotional narrative of her experiences with tobacco use, would be recalled more often and have a greater effect on smoking cessation than 3 other advertisements with different intended themes.MethodsOur data were derived from a sample of 2596 California adult smokers. We used multivariable log-binomial and modified Poisson regression models to calculate respondents' probability of quitting as a result of advertisement recall.ResultsMore respondents recalled the "Stages" ad (58.5%) than the 3 other ads (23.1%, 23.4%, and 25.6%; P

Proximal personal and environmental factors typically predict outcomes of treatment for alcohol or drug dependence (AODD), but longitudinal treatment studies have rarely examined these factors in adults with co-occurring psychiatric disorders. In adults with AODD and major depression, the aims of this study were to: (a) disaggregate person-and time-level components of network substance use and self-efficacy, (b) examine their prospective effects on posttreatment alcohol/drug use, and (c) examine whether residential environment moderated relations between these proximal factors and substance use outcomes. Veterans (N = 201) enrolled in a trial of group psychotherapy for AODD and independent MDD completed assessments every 3 months during 1 year of posttreatment follow-up. Outcome variables were percent days drinking (PDD) and using drugs (PDDRG). Proximal variables included abstinence self-efficacy and social network drinking and drug use. Self-efficacy and network substance use at the person-level prospectively predicted PDD (ps < .05) and PDDRG (ps < .05). Within-person, time-level effects of social networks predicted future PDD (ps < .05) but not PDDRG. Controlled environments moderated person-level social network effects (ps < .05), such that greater time in controlled settings attenuated the association between a heavier drinking/using network and posttreatment drinking and drug use. Both individual differences and time-specific fluctuations in proximal targets of psychosocial interventions are related to posttreatment substance use in adults with co-occurring AODD and MDD. More structured environmental settings appear to alleviate risk associated with social network substance use, and may be especially advised for those who have greater difficulty altering social networks during outpatient treatment.

BackgroundIndividuals with mental health conditions (MHC) have disproportionately high tobacco-related morbidity and mortality due to high smoking prevalence rates. As high consumers of cigarettes, smokers with MHC may consider using e-cigarettes as an alternative form of nicotine delivery.ObjectiveExamination of the susceptibility to use e-cigarettes by individuals with MHC.MethodsA U.S. population survey with a national probability sample (n=10,041) was used to assess ever use and current use of regular cigarettes, e-cigarettes, and U.S. Food and Drug Administration-approved pharmacotherapy for smoking cessation. Survey respondents provided information about whether they had been diagnosed with an anxiety disorder, depression, or other MHC.ResultsIndividuals with MHC were more likely to have tried e-cigarettes (14.8%) and to be current users of e-cigarettes (3.1%) than those without MHC (6.6% and 1.1%, respectively; p

ObjectiveExpectancies about social outcomes for smoking are relevant to college student smokers, who frequently report "social smoking." A new measure, the Social Facilitation Expectancies (SFE) scale, was developed to assess these beliefs.ParticipantsThe SFE was administered to undergraduate college student smokers (N = 1,096; study completed in May 2011).MethodsItems were scored on a 5-point scale with a summed total score. The sample was randomly split and principle axis factoring and confirmatory factor analysis applied to determine scale structure. The structure was tested across sex and smoking groups and validation analyses were conducted.ResultsA 9-item, 1-factor scale was replicated within each group. Higher SFE scores were observed among those with greater smoking experience and higher scores were associated with greater endorsement of other smoking-related beliefs.ConclusionsThese preliminary findings provide support for the sound psychometric properties of this measure for use with young adult college students.

ObjectiveLittle is known about the relationship between cigarette smoking initiation and subsequent alcohol involvement. To address this question, the present study compared alcohol use between students who initiated smoking during college and a matched sample of never-smoking students. We hypothesized greater increases in alcohol involvement among smoking initiators, mediated by exposure to cigarette use situations.MethodIncluded in the present study were 104 Chinese American and Korean American undergraduates who at baseline (freshman year) reported never having smoked a cigarette. Subjects were drawn from 433 participants in a naturalistic longitudinal study of tobacco use who were assessed annually each year in college. Cigarette smoking status was assessed annually as part of a structured interview. Initiators and never-smokers were matched on gender, ethnicity, baseline alcohol use, parental smoking status, and behavioral undercontrol.ResultsAs predicted, participants who initiated smoking during college reported significantly greater increases in the number of past-30-day total drinks consumed (p < .001) and reported greater prevalence of heavy drinking episodes (p < .05). The effect of smoking initiation on the change in the number of past-30-day drinks at the final assessment was partially mediated by exposure to smoking (p < .05). Exploratory analyses indicated that greater recent smoking significantly predicted increased alcohol consumption over and above the effect of exposure.ConclusionsStudents who initiate smoking during college appear at risk for increased alcohol involvement. Part of this risk is explained by environmental contextual factors, specifically exposure to situations involving other smokers that also may result in greater exposure to alcohol use.