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Background: Multiple strategies have been utilized in attempts to decrease the prevalence of youth tobacco use. One strategy, raising the minimum legal sale age (MLSA) of tobacco products to 21, known as Tobacco 21, has recently gained popularity. Tobacco 21 legislation targets youth tobacco use by obstructing two main sources of youth tobacco products: stores and older friends. Although these sources are the most common for youth across the nation, regional differences have not been explored. Further, youth perspectives about raising the tobacco MLSA have not been considered. Youth may help identify potential challenges to implementing tobacco control measures, as well as suggest alternatives for intervention, thus helping to shape successful tobacco control policies. Study Aim: This study aimed to 1) examine youth perspectives on raising the tobacco minimum legal sale age to 21 and 2) identify common sources of tobacco products among middle and high school students living in rural, low-income Appalachian communities. Methods: A cross-sectional survey about perceptions and use of tobacco products was conducted with students in the Appalachian regions of Kentucky and North Carolina (N=426). Questions were asked concerning perspectives on the effect of Tobacco 21 implementation. Descriptive statistics characterized participants by Tobacco 21 perspectives. Participants were given the opportunity to further expand upon their opinions in an open-ended format. Results: The majority (58.7%) of participants responded that the same number of youth would use tobacco if the legal purchase age were raised, followed by responses that fewer would use (28.9%) and more would use (12.4%). Significant differences emerged based on tobacco use status (p<0.05), friends' tobacco use (p<0.001), and whether participants identified family members as sources of youth tobacco products (p=0.047). When given the opportunity to expand upon their views concerning the implementation of Tobacco 21 laws in their communities, many respondents cited poor enforcement of tobacco MLSAs at stores, continued access to tobacco products from family members and friends, and the overall abundance of tobacco in their communities as potential barriers to the successful implementation. Conclusion: Fewer than one-third of participants believed that Tobacco 21 legislation would succeed in reducing the prevalence of youth tobacco use. Perspectives on the effect of Tobacco 21 legislation were related to personal tobacco use, exposure to tobacco users, and beliefs that family members provide tobacco products to youth. Open-ended responses identify potential obstacles in implementing Tobacco 21 legislation in Appalachia. Future research should attempt to include youth perspectives when designing and implementing tobacco control policies and examine family members as sources of tobacco products for youth.

Objective: Work examining the long-term impact of the COVID-19 pandemic on e-cigarette use among college students is limited. Therefore, the current study examined differences in college student e-cigarette users' changes in use behavior and risk perceptions as the pandemic continues. Participants: 129 undergraduate current e-cigarette users (Mage = 19.68, SD = 1.85; 72.1% female; 85.3% White). Methods: Participants completed an online survey between October 2020 and April 2021. Results: In terms of changes in frequency of e-cigarette use, 30.5% of participants increased their use and 23.4% decreased their use. Greater e-cigarette dependence and anxiety were associated with increased use. Nearly half of e-cigarette users reported increased motivation to quit, and 32.5% had made at least one quit attempt. Conclusions: A substantial number of students increased their e-cigarette use as a result of the COVID-19 pandemic. Cessation efforts targeting increased anxiety and dependence may be useful in this population. [ABSTRACT FROM AUTHOR]

Background: College students who identify as a sexual minority (i.e., lesbian, gay, bisexual, or other sexual orientation) are at higher risk for e-cigarette use than their heterosexual or "straight" peers. However, little is known about factors, such as e-cigarette outcome expectancies, that might influence these differences in prevalence rates. Therefore, the current study examined differences between heterosexual and sexual minority college student e-cigarette users in terms of days of past-month e-cigarette use, e-cigarette dependence, and e-cigarette outcome expectancies. A secondary aim of the study was to examine whether outcome expectancies served as an explanatory mechanism in the association between sexual minority status and e-cigarette use frequency and dependence. Methods: Participants were heterosexual (n = 90; Mage = 19.65, SD = 2.70; 76.7% female; 77.8% White) and sexual minority (n = 44; Mage = 20.02, SD = 2.18; 68.2% female; 90.9% White) college student e-cigarette users who completed self-report measures. Results: Students who identified as a sexual minority reported greater e-cigarette dependence, more frequent past 30-day use, and greater negative consequences and positive reinforcement e-cigarette outcome expectancies. Follow-up mediation analyses indicated a significant indirect effect of sexual minority status on both days of past-month e-cigarette use and e-cigarette dependence through expectancies for negative consequences and positive reinforcement. Conclusions: These findings suggest that positive reinforcement and negative consequences outcome expectancies may be contributing to the disparities in e-cigarette use among college students who identify as a sexual minority and could be useful targets for cessation interventions for this population. [ABSTRACT FROM AUTHOR]

Objective: The current study examined group differences in college students' views on e-cigarettes in terms of safety, popularity, health risks, social acceptability, efficacy as a cessation aid, and promoting combustible cigarette use. Participants: 337 undergraduates (Mage = 20.84, SD = 3.79; 72.1% female; 68.5% White) divided into three groups: Never Users (n = 178), Ever Users (n = 108), and Current Users (n = 51). Methods: Participants completed questionnaires for course credit. Results: Compared to Ever and Never Users, Current Users believed e-cigarettes were safer, healthier, a useful tool to quit smoking, did not lead to combustible cigarette smoking, and that nicotine was less dangerous. Current Users also were less likely to endorse boosting social image as a motive for use. Conclusions: Public health campaigns could benefit from targeting current users' positive beliefs about e-cigarettes to reduce the prevalence of e-cigarette use among college students. [ABSTRACT FROM AUTHOR]

Understanding the association between initial experimentation with a tobacco product and subsequent patterns of tobacco use among youth is important to informing prevention activities for youth in the US. We conducted an online survey from August to October 2017 among youth aged 13–18 years. The current analysis focused on respondents reporting initial experimentation with any tobacco product (n = 2,022). Using multinomial logistic regression, we examined the association between first tobacco product tried (cigarettes; cigars including cigarillos, little cigars, and bidis; electronic nicotine delivery systems (ENDS); smokeless and chewing tobacco; or hookah) with subsequent patterns of tobacco use while adjusting for covariates. Of the youth who experimented, 56.8% were non-current tobacco users. Of current tobacco users (n = 934), 13% were exclusive ENDS users, 5.3% exclusive combustible mono-users, 13.4% ENDS plus combustible poly-users, 3.3% combustible product only poly-users, and 8.2% other tobacco poly-users. The most common type of first tobacco product tried was ENDS (44.7%), followed by cigarettes (35.0%) and cigars (8.6%). Those who experimented with combustible tobacco products were less likely to be exclusive ENDS users [Relative Risk Ratio (RRR) = 0.46; 95% CI = 0.28, 0.73 for cigarettes; RRR = 0.32; 95% CI = 0.13, 0.81 for cigars; and RRR = 0.33; 95% CI = 0.14, 0.79 for hookah] when compared to non-current tobacco users (reference group). Tobacco product choices for initial experimentation appear to play a role in subsequent tobacco use patterns among youth. Understanding the reasons behind initial product choice may inform our understanding regarding the reasons for subsequent current tobacco product use, thus informing youth prevention efforts. [ABSTRACT FROM AUTHOR]

The present study sought to examine associations between anxiety sensitivity and both sleep and physical activity among college students, who are particularly vulnerable to sleep disturbance, decreased physical activity, and the development of psychopathology, especially in the wake of the COVID-19 pandemic. Participants were 683 college students (Mage = 20.33, SD = 3.58; 72% female; 70.3% White) who completed self-report measures online for course credit. Results indicated that after controlling for the effects of age, gender identity, and race, greater sleep disturbance was significantly associated with higher overall anxiety sensitivity (7% unique variance; β = 0.27, t = 6.67, p <.001) as well as its three subdomains (physical concerns: 4% variance; β = 0.21, t = 4.97, p <.001; cognitive concerns: 6% variance; β = 0.25, t = 6.17, p <.001; social concerns: 6% variance; β = 0.26, t = 6.22, p <.001). Additionally, more time spent walking was associated with greater anxiety sensitivity physical concerns (1% variance; β = 0.11, t = 2.52, p =.012) and greater vigorous intensity physical activity was associated with lower anxiety sensitivity social concerns (1% variance; β = −0.13, t = −2.76, p =.006). These findings suggest that sleep problems may be more universally relevant to anxiety sensitivity than physical activity and interventions to promote healthier sleep may be useful for decreasing anxiety sensitivity in college students. [ABSTRACT FROM AUTHOR]