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Supplementary Tables 1-2 from Exposure to Smoking Imagery in the Movies and Experimenting with Cigarettes among Mexican Heritage Youth

There is growing evidence that an adolescent's decision to try cigarettes is influenced by level of exposure to movies in which smoking is portrayed. Less is known about how ethnicity affects this process. We examined whether acculturation and/or country of birth influence the relationship between exposure to smoking imagery in the movies and experimenting with cigarettes among Mexican origin youth. We prospectively followed 1,328 Mexican origin adolescents ages 11 to 13 years at baseline. We assessed which of 50 movies (randomly selected from a pool of 250 popular contemporary movies released from 1999 to 2004 and content analyzed for smoking) adolescents had seen. Smoking behavior was assessed at baseline and at 6-month intervals over 24 months. Ten percent of the adolescents had experimented at baseline; 17% tried subsequently. Multivariate analyses revealed, as exposure to smoking imagery in the movies increased, the chances of having ever experimented [adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI), 1.10-1.48] and of being a new experimenter (AOR = 1.19; 95% CI, 1.01-1.40) increased, equivalent to a 4.2% increased risk of ever and a 3.0% increased risk of new experimenting for each additional quartile of movie exposure. This effect was moderated by country of birth. For Mexican-born youth, exposure to smoking imagery in the movies was the strongest independent predictor of new experimentation (AOR = 1.52; 95% CI, 1.14-2.05). For U.S.-born youth, we observed a ceiling effect: the percent of experimenters increased with increasing exposure, and then flattened. Among Mexican-born youth, exposure to smoking imagery in the movies may be an important part of the acculturation process associated with smoking initiation. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3435–43)

Supplementary Tables 3-4 from Exposure to Smoking Imagery in the Movies and Experimenting with Cigarettes among Mexican Heritage Youth

IntroductionThe extent of the population’s exposure to tobacco imagery across all genres of regular TV programming and the contribution of each of these genres is unknown, except for UK broadcast channels. The objective of this study is to estimate the exposure of young people to tobacco imagery on Chilean prime-time television and the programme source contributing to such exposure.MethodsProgrammes aired during 3 weeks in 2019 from the 15 highest audience channels in Chile were content-analysed for the occurrence of tobacco categorised as actual use, implied use, tobacco paraphernalia, tobacco brand appearances and whether they violated Chilean smoke-free law for each 1 min interval (92 639). The exposure of young people to tobacco content was estimated using media viewership figures.ResultsYoung people received 29, 11 and 4 million tobacco impressions of any type, explicit use and smoke-free violation, respectively, at a rate of 21.8, 8.0 and 2.1 thousand impressions per hour of TV viewing. The main sources of exposure to tobacco impressions were feature films and animated productions, which were almost entirely non-Chilean. Finally, young people were exposed to tobacco brand impressions primarily through films, effectively circumventing the advertising ban in Chile.DiscussionTelevision programming is a source of significant youth exposure to tobacco imagery, including branding impressions. To conform to the WHO FCTC, Chile should prohibit tobacco branding in any TV programme and require strong anti-tobacco advertisements prior to any TV programme portraying tobacco.

Introduction We examined the relationship between current tobacco use and functionally important respiratory symptoms. Methods Longitudinal cohort study of 16 295 US adults without COPD in Waves 2–3 (W2–3, 2014–2016) of the Population Assessment of Tobacco and Health Study. Exposure—Ten mutually exclusive categories of tobacco use including single product, multiple product, former, and never use (reference). Outcome—Seven questions assessing wheezing/cough were summed to create a respiratory symptom index; cutoffs of ≥2 and ≥3 were associated with functional limitations and poorer health. Multivariable regressions examined both cutoffs cross-sectionally and change over approximately 12 months, adjusting for confounders. Results All tobacco use categories featuring cigarettes (>2/3’s of users) were associated with higher risk (vs. never users) for functionally important respiratory symptoms at W2, for example, at symptom severity ≥ 3, risk ratio for exclusive cigarette use was 2.34 [95% CI, 1.92, 2.85] and for worsening symptoms at W3 was 2.80 [2.08, 3.76]. There was largely no increased symptom risk for exclusive use of cigars, smokeless tobacco, hookah, or e-cigarettes (adjustment for pack-years and marijuana attenuated the cross-sectional e-cigarette association from 1.53(95% CI 0.98, 2.40) to 1.05 (0.67, 1.63); RRs for these products were also significantly lower compared to exclusive use of cigarettes. The longitudinal e-cigarette–respiratory symptom association was sensitive to the respiratory index cutoff level; exclusive e-cigarette use was associated with worsening symptoms at an index cutoff ≥ 2 (RR = 1.63 [1.02, 2.59]) and with symptom improvement at an index cutoff of ≥ 3 (RR = 1.64 [1.04, 2.58]). Conclusions Past and current cigarette smoking drove functionally important respiratory symptoms, while exclusive use of other tobacco products was largely not associated. However, the relationship between e-cigarette use and symptoms was sensitive to adjustment for pack-years and symptom severity. Implications How noncigarette tobacco products affect respiratory symptoms is not clear; some studies implicate e-cigarettes. We examined functionally important respiratory symptoms (wheezing/nighttime cough) among US adults without COPD. The majority of adult tobacco users smoke cigarettes and have higher risk of respiratory symptoms and worsening of symptoms, regardless of other products used with them. Exclusive use of other tobacco products (e-cigarettes, cigars, smokeless, hookah) was largely not associated with functionally important respiratory symptoms and risks associated with their use was significantly lower than for cigarettes. The association for e-cigarettes was greatly attenuated by adjustment for cigarette pack-years and sensitive to how symptoms were defined.

Exposure to alcohol content in the media, especially in movies, is a demonstrated risk factor for adolescent alcohol use. This paper examines processes underlying this association and whether parenting mitigates such harms. A mediational model of parental restriction of mature media (W1), alcohol content exposure (W2), alcohol expectancies, peer norms (W3), and alcohol outcomes (W4) was tested using annual assessments from a study of adolescent drinking (N = 879; 52% female; 21% Non-White; 12% Hispanic). When restrictions are not in place, adolescents report greater exposure to alcohol content, leading to higher perceived peer drinking. Parental monitoring did not buffer the link between exposure and peer norms. Parental media restriction and perceptions about peers comprise mechanisms by which alcohol-saturated media influences youth drinking.

BackgroundResearch on cigarettes and adult asthma offers mixed findings, perhaps due to overlap with chronic obstructive pulmonary disease (COPD) and inadequate adjustment for other smoke exposures. Associations between other tobacco products, including e-cigarettes, and asthma are also understudied.Research questionUsing Population Assessment of Tobacco and Health Study waves 2–4 (2014/2015–2016/2017) data, we assessed the relation between tobacco product use and asthma in persons unlikely to have COPD.Study design and methodsProspective study of 10 267 adults aged 18–39 years without COPD diagnoses. Past-month tobacco use at wave 2 was modelled first as combustible versus non-combustible use and second as specific product categories (former, cigarettes, e-cigarettes, cigars, hookah, smokeless tobacco). Outcomes included lifetime asthma prevalence at wave 2, incidence (waves 3 and 4) and Asthma Control Test score (lower=worse). Multivariable regressions adjusted for predictors of asthma, including other smoke exposures: cigarette pack-years, secondhand smoke and marijuana use. Sensitivity analyses examined findings when persons >39 years and those with both COPD and asthma were added, and when smoke exposure adjustments were removed.ResultsNo product, including cigarettes and e-cigarettes, was associated with prevalence or incidence of asthma. Among people with asthma at wave 2, combustible tobacco (beta=−0.86, 95% CI (−1.32 to –0.39)) and cigarettes (beta=−1.14, 95% CI (−1.66 to –0.62)) were associated with worse asthma control. No tobacco product was associated with asthma control over time. In sensitivity analyses, tobacco use became associated with incident asthma as adults >39 years and those with asthma+COPD were added, and as adjustments for other smoke exposures were omitted.InterpretationAlthough cigarette use was associated with worse asthma control, there were no longitudinal associations between combustible tobacco or e-cigarette use and new onset or worsening asthma in these preliminary analyses. Research on tobacco and asthma should exclude COPD and adjust for smoking history and other smoke exposures.

OBJECTIVE Subgroups of adolescent single and dual e-cigarette and cigarette users have been identified, but usage patterns have changed in recent years, and there has been an increase in marijuana use. Research is needed with current data to identify subgroups of use including marijuana and determine their behavioral correlates. METHODS We cross classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students in the 2019 Youth Risk Behavior Survey (YRBS), providing 8 different groups. Levels of 14 risk and protective factors were compared across groups in general linear models with demographic covariates using omnibus tests, pairwise comparisons, and planned contrasts. Replicability was tested through identical analyses for 2017 YRBS data. RESULTS The nonuser group was 43.9% of the sample. The most frequent user groups were triple users (ever-use proportion: 16.9%), dual (e-cigarette and marijuana) users (15.8%), and exclusive e-cigarette users (13.2%). For risk profiles on levels of psychosocial variables, the triple-user group was typically elevated above all other groups. Exclusive e-cigarette users were above nonusers in risk profile but below dual users (both cigarettes and marijuana). Results were similar for ever use and recent use. The patterning of results in 2019 YRBS data were closely replicated in 2017 YRBS data. CONCLUSIONS Co-occurrence of e-cigarette, cigarette, and marijuana use is currently substantial among adolescents and is associated with an elevated psychosocial risk profile. This has implications for both epidemiology and prevention studies. Further research is needed to study prevalence and identify pathways to triple use.

The purpose of this study is to validate the seven-item wheezing module from the International Study of Asthma and Allergies in Children (ISAAC) in the nationally representative Population Assessment of Tobacco and Health Study. Adult participants with complete Wave 2–3 data were selected, including those with asthma but excluding those with COPD and other respiratory diseases (n = 16,295). We created a nine-point respiratory symptom index from the ISAAC questions, assessed the reliability of the index, and examined associations with self-reported asthma diagnosis. Threshold values were assessed for association with functional outcomes. The weighted prevalence for one or more respiratory symptom was 18.0% (SE = 0.5) for adults without asthma, 70.1% (SE = 1.3) for those with lifetime asthma, 75.7% (SE = 3.7) for adults with past-year asthma not on medications, and 92.6% (SE = 1.6) for those on medications. Cronbach’s alpha for the respiratory symptom index was 0.86. Index scores of ≥2 or ≥3 yielded functionally important respiratory symptom prevalence of 7–10%, adequate sensitivity and specificity for identifying asthma, and consistent independent associations with all functional outcomes and tobacco use variables. Respiratory symptom index scores of ≥2 or ≥3 are indicative of functionally important respiratory symptoms and could be used to assess the relationship between tobacco use and respiratory health.

Aim We tested the hypothesis that waterpipe smoking increases the likelihood to try conventional and electronic cigarettes. Methods In 2017 and 2018, 2752 German adolescents (mean age: 14.9 years), who had never tried conventional cigarettes or e-cigarettes, took part in a longitudinal survey with a 6-month observational period. Multiple regression analyses tested the association between waterpipe use at baseline and first experimentation with e-cigarettes at follow-up. The models adjusted for risk-taking propensity (sensation seeking and experimentation with alcohol and marijuana), age, sex, migration background, type of school and peer substance use. Results Some 381 adolescents (12.5% of the survey population) reported waterpipe smoking at baseline. The overall initiation rate during the 6 months was 4.9% (n=134) for conventional cigarettes and 10.5% (n=288) for e-cigarettes. Prior waterpipe smoking significantly predicted cigarette use (adjusted relative risk (ARR)=1.81, 95% CI 1.19–2.76), as well as e-cigarette use (ARR=3.29, 95% CI 2.53–4.28). In addition, a significant interaction between waterpipe use and sensation seeking was found (ARR=0.56, 95% CI 0.33–0.95), with waterpipe use being more predictive of later e-cigarette initiation for lower sensation-seeking individuals. Discussion Waterpipe use predicted both later cigarette and e-cigarette use independent of all other assessed risk factors, indicating that waterpipe use might be a risk factor on its own. The results suggest that the association was stronger for adolescents with a lower risk-taking propensity, which brings this group into focus for prevention efforts. However, further research is needed to understand whether these associations are causal., In a large cohort of German adolescents, an association of prior hookah use with later use of cigarettes and e-cigarettes was found. Both associations were independent of adolescents’ propensity to seek risk. https://bit.ly/3lxY2bJ

Introduction Type of e-cigarette flavoring and device during first use might differentiate later e-cigarette use and dependence. This retrospective cross-sectional study examined associations of recalled first nicotine vaping device and flavor used with current vaping frequency/dependence. Aims and Methods A young adult cohort from Los Angeles, California, USA completed web-based surveys (N = 2553). Using cross-sectional data from 971 reporting ever vaping nicotine, multivariable hurdle regressions tested associations between recalled first flavor (fruit/sweet, menthol/mint, other) and device (Juul, disposable, mod, box, pod, pen, other) vaped with past-30-day vaping status (yes/no) and frequency (1–30 days), and with any vaping dependence symptoms (yes/no) and count (1–10 symptoms). Results The most common first-flavor was sweet (71%); the most common first-device was a vape pen (37%), then Juul (22%). First-flavor of mint/menthol (vs. other; adjusted odds ratio [AOR]: 2.22[95% CI = 1.16 to 4.25]), and first-device mod (AOR = 2.40[95% CI = 1.34 to 4.31]) and non-Juul pod (2.64[95% CI = 1.41 to 4.92]) (vs. pen) were associated with past-30-day vaping, and twice as many vaping days (adjusted rate ratios [ARRs] range: 1.96–2.12; ps < .05). First flavor of mint/menthol (vs. other; AOR: 1.95[95% CI = 1.003 to 3.79) and first device mod, box, non-Juul pod, and other (AORs range: 2.36–4.01; ps < .05) were associated with nicotine dependence. First device Juul, mod, box, and non-Juul pod were also associated with more dependence symptoms (ARRs range:1.38–1.59; ps < .05). Conclusions Exposure to mint/menthol and certain devices (mod, box, Juul, and non-Juul pods) at first e-cigarette use may be associated with more frequent e-cigarette use and nicotine dependence symptoms in young adulthood. Mint/menthol and certain devices warrant consideration in regulation of e-cigarettes based on product characteristics. Implications Characteristics (flavor and device type) of first e-cigarette product used were associated with higher usage and more dependence. Pending replication with prospective designs, the findings suggest certain flavors (mint/menthol) and devices (pods, mods) merit consideration in regulation because of their possible link with continued use and dependence among young people.

Background: Cardiovascular disease is a key health condition associated with tobacco use, however, clinical measures are not typically possible in population-based studies. In this paper, we assess the reliability and validity of self-reported cardiovascular risk factors and diseases in a large nationally representative study of tobacco use and health outcomes. Methods: This paper analyzes self-reported cardiovascular risk factors and disease among adults age 40 years and older based on U.S. nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study. Prevalence of cardiovascular risk factors (self-reported high blood pressure, high cholesterol, diabetes and family history of premature heart disease, BMI ≥ 35, and tobacco use) and cardiovascular disease (self-reported heart attack, stroke and/or congestive heart failure (CHF)) were considered along with ratings of physical functioning, fatigue, and general health. Results: Self-reported cardiovascular disease was found to be associated with functional health measures (walking up a flight of stairs) and general ratings of health. Prospective analyses found strong correlations between sequential data collection waves for history of hypertension, elevated cholesterol and CHF, while more modest correlations were noted for stroke and heart attack. The overall prevalence of cardiovascular disease and hypertension was comparable to those from the National Health and Nutrition Examination Survey (NHANES). Conclusions: These analyses suggest reliability and concurrent validity regarding self-reported cardiovascular risk factors and disease assessed in the PATH Study.

BackgroundEvidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking.MethodsOur analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013–2014; Wave 2 [W2] 2014–2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided.ResultsIn weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P ConclusionsEver-ENDS use predicts future cigarette smoking, and frequency of ENDS use has a differential impact on subsequent cigarette smoking uptake or reduction. These results suggest that both cigarettes and ENDS should be targeted in early tobacco prevention efforts with youth.

OBJECTIVE: This study assesses the association between exposure to alcohol in movies and alcohol use transitions among Latin American adolescents. METHOD: A school-based longitudinal study involving 33 secondary schools in Argentina and 57 in Mexico was performed. The baseline sample included 1,504 never drinker adolescents in Argentina and 5,264 in Mexico (mean age = 12.5 years), of whom 1,055 and 3,540, respectively, completed a follow-up survey a year and a half later. Exposure to the 500 popular contemporary films was assessed by querying adolescents on 50 randomly selected titles. Films were content-coded for alcohol and exposure estimated from films seen. Logistic regression models estimated adjusted relative risk (aRR) for the following outcomes, net covariates, at follow-up: use of alcohol (having ever drank), current drinking (drinking in the past 30 days), ever binge drinking (≥ 4 drinks [females] or 5 for males). RESULTS: At follow-up, respective adolescent drinking rates for Mexico and Argentina were 31% and 36% for use of alcohol, 18% and 27% for current drinking, and 8% and 19% for ever binge drinking. Greater exposure to alcohol in movies was independently associated with trying alcohol (aRR = 1.30, 95% CI [1.17, 1.43]), current drinking (aRR = 1.22, 95% CI [1.03, 1.44]), and binge drinking (aRR = 1.71, 95% CI [1.30, 2.25]) in Mexican adolescents, whereas in Argentina, movie alcohol exposure was associated only with trying alcohol (aRR = 1.25, 95% CI [1.02, 1.53]). CONCLUSIONS: Exposure to alcohol in movies predicted underage drinking transitions in these Latin American adolescents, replicating prior results for U.S. and European cohorts.

BACKGROUND: Fast-food intake is a modifiable obesity risk factor in early childhood, and child-directed fast-food marketing is common. Per self-regulatory guidelines regarding deception, premiums (ie, incentives or toy giveaways) in child-directed advertisements must be secondary to the advertised product. METHODS: Content analyses were performed of all child-directed fast-food television (TV) advertisements aired on four national US children’s TV networks, February 1, 2019, through January 31, 2020, to assess the emphasis of premiums relative to food. We quantified the percent of the audio transcript (word count) and visual airtime (seconds) that included premiums or food and the on-screen size of premiums relative to food in randomly selected frames from each advertisement. RESULTS: There were 28 unique child-directed advertisements for children’s fast-food meals in the study year; 27 advertisements were from one restaurant and accounted for nearly all (99.8%) of the total airtime for the 28 advertisements. Premiums were present in 27 of the 28 unique advertisements. On average, premiums (versus food) accounted for 53.0% (vs 16.0%) of words in the audio transcript and 59.2% (vs 54.3%) of the visual airtime per advertisement. In the random subset of frames that includes both premiums and food imagery, imagery of premiums accounted for 9.7% (95% CI: 6.4%–13.0%) of the on-screen area, whereas imagery of food accounted for 5.7% (95% CI: 4.4%–7.0%), an average ratio of 1.9:1 within each frame when excluding one large outlier. CONCLUSIONS: Child-directed fast-food TV advertisements emphasize premiums over food in violation of self-regulatory guidelines, counter to childhood obesity prevention efforts.

Objective: This article summarizes the findings of narrative and systematic literature reviews focused on the relationship between exposure to alcohol marketing and youth drinking, viewed in context of criteria for causality. We also consider the implications of this proposition for alcohol policy and public health. Method: Our descriptive synthesis of findings is from 11 narrative and systematic reviews using the nine Bradford Hill causality criteria: (a) strength of association, (b) consistency, (c) specificity of association, (d) temporality, (e) biological gradient, (f) biological plausibility, (g) coherence, (h) experimental evidence, and (i) analogy. Results: Evidence of causality for all nine of the Bradford Hill criteria was found across the review articles commissioned for this supplement and in other previously published reviews. In some reviews, multiple Bradford Hill criteria were met. The reviews document that a substantial amount of empirical research has been conducted in a variety of countries using different but complementary research designs. Conclusions: The research literature available today is consistent with the judgment that the association between alcohol marketing and drinking among young persons is causal.

To clarify and quantify the influence of video game violence (VGV) on aggressive behavior, we conducted a metaanalysis of all prospective studies to date that assessed the relation between exposure to VGV and subsequent overt physical aggression. The search strategy identified 24 studies with over 17,000 participants and time lags ranging from 3 months to 4 years. The samples comprised various nationalities and ethnicities with mean ages from 9 to 19 years. For each study we obtained the standardized regression coefficient for the prospective effect of VGV on subsequent aggression, controlling for baseline aggression. VGV was related to aggression using both fixed [β = 0.113, 95% CI = (0.098, 0.128)] and random effects models [β = 0.106 (0.078, 0.134)]. When all available covariates were included, the size of the effect remained significant for both models [β = 0.080 (0.065, 0.094) and β = 0.078 (0.053, 0.102), respectively]. No evidence of publication bias was found. Ethnicity was a statistically significant moderator for the fixed-effects models ( P ≤ 0.011) but not for the random-effects models. Stratified analyses indicated the effect was largest among Whites, intermediate among Asians, and nonsignificant among Hispanics. Discussion focuses on the implications of such findings for current debates regarding the effects of violent video games on physical aggression.

BackgroundOur objective was to assess whether exposure to tobacco in video games is associated with smoking among adolescent gamers from Argentina.MethodsCross-sectional data were analysed from students in public and private middle schools in Argentina. Tobacco content in video games was estimated using previously validated methods and adolescents’ tobacco exposure was assessed by multiplying tobacco content in the top three video games they play by the hours played per day. The primary outcome was current smoking. Multilevel logistic regression models adjusted for clustering within schools, regressing current smoking on tobacco exposure in video games (ie, none, low, high) after controlling for age, sex, parental education, parenting style, parental rules about the use of video games, rebelliousness, sensation seeking and ‘technophilia’.ResultsOf the 3114 students who participated, 92% of boys (1685/1802) and 56% of girls (737/1312) played video games and were included in the analytical sample. The prevalence of smoking was 13.8% among boys and 22.0% among girls; 74.5% of boys played video games more than 1 hour per day compared with 47.7% of girls. High exposure to tobacco content in video games compared with no exposure was independently associated with current smoking among girls (OR 1.78; 95% CI 1.02 to 3.09) but not among boys (OR 0.98; 95% CI 0.64 to 1.51).ConclusionsGreater exposure to tobacco content in video games was associated with higher likelihood of smoking among Argentine girls who play video games, suggesting the need for policies that limit these exposures.

Objective To assess changes in engagement with online tobacco and electronic cigarette (e-cigarette) marketing (online tobacco marketing) among adolescents in the United States between 2013 and 2015. Methods We assessed the prevalence of six forms of engagement with online tobacco marketing, both overall and by brand, among adolescents sampled in Wave 1 (2013–2014; n = 13651) and Wave 2 (2014–2015; n = 12172) of the nationally representative Population Assessment for Tobacco and Health Study. Engagement was analyzed by tobacco use status: non-susceptible never tobacco users; susceptible never tobacco users; ever tobacco users, but not within the past year; and past-year tobacco users. Results Among all adolescents, the estimated prevalence of engagement with at least one form of online tobacco marketing increased from 8.7% in 2013–2014 to 20.9% in 2014–2015. The estimated prevalence of engagement also increased over time across all tobacco use statuses (eg, from 10.5% to 26.6% among susceptible adolescents). Brand-specific engagement increased over time for cigarette, cigar, and e-cigarette brands. Conclusion Engagement with online tobacco marketing, both for tobacco and e-cigarettes, increased almost twofold over time. This increase emphasizes the dynamic nature of online tobacco marketing and its ability to reach youth. The Food and Drug Administration, in cooperation with social networking sites, should consider new approaches to regulate this novel form of marketing. Implications This is the first study to estimate the national prevalence of engagement with online tobacco marketing among adolescents over time. The estimated prevalence of this engagement approximately doubled between 2013–2014 and 2014–2015 among all adolescents and, notably, among adolescents at relatively low risk to initiate tobacco use. This increase in engagement could represent public health harm if it results in increased initiation and use of tobacco products. Stronger federal regulation of online tobacco marketing and tighter control of access to tobacco-related content by social media sites could reduce adolescents’ exposure to and engagement with online tobacco marketing.

Objective:In this study, we assess whether activation of the brain’s reward system in response to alcohol advertisements is associated with college drinking. Previous research has established a relationship between exposure to alcohol marketing and underage drinking. Within other appetitive domains, the relationship between cue exposure and behavioral enactment is known to rely on activation of the brain’s reward system. However, the relationship between neural activation to alcohol advertisements and alcohol consumption has not been studied in a nondisordered population.Method:In this cross-sectional study, 53 college students (32 women) completed a functional magnetic resonance imaging scan while viewing alcohol, food, and control (car and technology) advertisements. Afterward, they completed a survey about their alcohol consumption (including frequency of drinking, typical number of drinks consumed, and frequency of binge drinking) over the previous month.Results:In 43 participants (24 women) meeting i...

Background Alternative methods for consuming cannabis (e.g., vaping and edibles) have become more popular in the wake of U.S. cannabis legalization. Specific provisions of legal cannabis laws (LCL) (e.g., dispensary regulations) may impact the likelihood that youth will use alternative methods and the age at which they first try the method – potentially magnifying or mitigating the developmental harms of cannabis use. Methods This study examined associations between LCL provisions and how youth consume cannabis. An online cannabis use survey was distributed using Facebook advertising, and data were collected from 2630 cannabis-using youth (ages 14–18). U.S. states were coded for LCL status and various LCL provisions. Regression analyses tested associations among lifetime use and age of onset of cannabis vaping and edibles and LCL provisions. Results Longer LCL duration (OR vaping : 2.82, 95% CI: 2.24, 3.55; OR edibles : 3.82, 95% CI: 2.96, 4.94), and higher dispensary density (OR vaping : 2.68, 95% CI: 2.12, 3.38; OR edibles : 3.31, 95% CI: 2.56, 4.26), were related to higher likelihood of trying vaping and edibles. Permitting home cultivation was related to higher likelihood (OR: 1.93, 95% CI: 1.50, 2.48) and younger age of onset (β: −0.30, 95% CI: −0.45, −0.15) of edibles. Conclusion Specific provisions of LCL appear to impact the likelihood, and age at which, youth use alternative methods to consume cannabis. These methods may carry differential risks for initiation and escalation of cannabis use. Understanding associations between LCL provisions and methods of administration can inform the design of effective cannabis regulatory strategies.

Objective The utility of studying substance use during early adolescence depends on how well indicies of lower-level experimentation predict the development of substance use problems. We examined associations between experimental cigarette use at T1, recanting of use 8 months later (T2), and daily smoking at 2 years (T4). Methods Longitudinal telephone survey of 6522 US youth aged 10–14, examining lifetime cigarette smoking (none, just puffing, 1–19, 20–100, >100) and recanting (i.e., reporting lifetime use at T1, denying ever using at T2) as predictors of T4 daily smoking using multivariable logistic regression. Covariates included sociodemographics, friend/family smoking, school performance, and personality characteristics. Results The sample was 51% male, 18% Black, 17% Hispanic, with 70% retained at T2. At T1, 407 (8.9%) adolescents reported some smoking, of whom 85 (20.9%) recanted at T2. At T4, 970 reported any smoking, of whom 88 (9.1%) were daily smokers. Any T1 experimentation identified two-thirds of T4 daily smokers (sensitivity = 66.7%) with a false positive rate of 7.8%. T1 lifetime smoking categories were associated with the following adjusted odds ratios for T4 daily smoking (vs. never smokers): 2.7 for recanters (95% confidence interval 0.82, 8.5), 3.5 for few puffs (1.7, 7.0), 9.6 for 1–19 cigarettes (4.1, 22.3), 3.8 for 20–100 cigarettes (1.0, 14.3), and 30.1 for >100 cigarettes (8.1, 111). Conclusions In this sample experimentation with cigarettes predicted future daily smoking with high utility. The findings provide a rationale for monitoring and reporting any experimentation cigarettes as a tobacco surveillance outcome.

Objective: To examine and compare overall prevalence and time trends in tobacco and alcohol portrayals and brand appearances in youth-rated US and nationally-produced films that were the most successful in Argentina and Mexico from 2004-2012. Materials and methods: Top-grossing nationally produced films from Argentina (n=73), Mexico (n=85) and the US (n=643) were content analyzed. Logistic regression was used to determine differences between Mexican, Argentine and US produced films. Linear regression models assessed significant cross-country differences in the mean number of tobacco and alcohol seconds. Results: Films from Mexico and Argentina were more likely than US films to contain tobacco, (OR=4.2; p

Background Approximately 20% of deaths in the US each year are attributable to smoking, yet current practices in the recording of this health risk in electronic health records (EHRs) have not led to discernable changes in health outcomes. Several groups have developed algorithms for extracting smoking behaviors from clinical notes, but none of these approaches were assessed with external data to report on anticipated clinical performance. Methods Previously, we developed an informatics pipeline that extracts smoking status, pack year history, and cessation date from clinical notes. Here we report on the clinical implementation performance of our pipeline using 1,504 clinical notes matched to an external questionnaire. Results We found that 73% of available notes contained no smoking behavior information. The weighted Cohen’s kappa between the external questionnaire and EHR smoking status was 0.62 (95% CI 0.56–0.69) for the clinical notes we were able to extract information from. The correlation between pack years reported by our pipeline and the external questionnaire was 0.39 on the 81 notes for which this information was present in both. We also assessed for lung cancer screening eligibility using notes from individuals identified as never smokers or smokers with pack year history extracted by our pipeline (n = 196). We found a positive predictive value of 85.4%, a negative predictive value of 83.8%, sensitivity of 63.1%, and specificity of 94.7%. Conclusions We have demonstrated that our pipeline can extract smoking behaviors from unannotated EHR notes when the information is present. This information is reliable enough to identify patients most likely to be eligible for smoking related services. Ensuring capture of smoking information during clinical encounters should continue to be a high priority.

Mexican American adolescents report high rates of alcohol consumption as well as media use. Viewing alcohol images in the media is associated with increased alcohol consumption; however, to date, this association has not been examined across different ethnic groups in the United States. To bridge this gap, we examined the association between viewing alcohol use images in PG-13-rated movies and alcohol initiation in Mexican-heritage adolescents. A cohort of 1,154 Mexican-heritage youth, average age 14 years, was followed for 2 years; in 2008-2009, participants reported alcohol use in the past 30 days and again in 2010-2011. Exposure to alcohol use images in PG-13-rated movies was estimated from 50 movies randomly selected from a pool of 250 of the top box office hits in the United States using previously validated methods. A series of generalized linear models, adjusting for age, gender, peer and family alcohol use, family functioning, anxiety, sensation-seeking tendency, and acculturation were completed. Multiple imputation was utilized to address missing data. Overall, N = 652 participants reported no alcohol use in 2008-2009; by 2010-2011, 33.6% (n = 219) had initiated alcohol use. Adjusted models indicated an independent association between exposure to alcohol use images in PG-13-rated movies and alcohol initiation (comparing quartiles 3 to 1: RR =1.53; 95% CI [1.11, 2.10]). The findings emphasize that the relationship between viewing alcohol use scenes in American films and alcohol initiation holds among Mexican-heritage adolescents and underscore the need to limit adolescents' exposure to such powerful images in PG-13-rated movies.

Background: In Europe and the United States, family relationships and parenting behavior can influence youth substance use, but less is known about their influence in Latin American countries. Objective: To explore whether parenting behavior is associated with substance use among Latin American youth. Methods: A cross-sectional, school-based survey of middle-school youth (n = 3172) in three Argentinian cities queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Parenting behavior was assessed with previously validated items that tapped into demandingness and responsiveness, separately for mothers and fathers. Multilevel logistic regression models assessed associations between parenting behavior and substance use after adjusting for student characteristics, socioeconomic indicators, sensation seeking, and smoking amongst peers and family members. Results: Substance use prevalence was 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day bing...

BACKGROUND/OBJECTIVE Exposure to food advertisements may cue overeating among children, especially among those genetically predisposed to respond to food cues. We aimed to assess how television food advertisements affect eating in the absence of hunger among children in a randomized trial. We hypothesized that the Fat Mass and Obesity Associated Gene (FTO) rs9939609 single nucleotide polymorphism would modify the effect of food advertisements. SUBJECTS/METHODS In this randomized experiment, 200 children aged 9–10 years old were served a standardized lunch and then shown a 34-minute television show embedded with either food or toy advertisements. Children were provided with snack food to consume ad libitum while watching the show and we measured caloric intake. Children were genotyped for rs9939609 and analyses were conducted in the overall sample and stratified by genotype. A formal test for interaction of the food ad effect on consumption by rs9939609 was conducted. RESULTS 172 unrelated participants were included in this analysis. Children consumed on average 453 (SD=185) kCals during lunch and 482 (SD=274) kCals during the experimental exposure. Children who viewed food advertisements consumed an average of 48 kCals (95% CI: 10, 85; P=0.01) more of a recently advertised food than those who viewed toy advertisements. There was a statistically significant interaction between genotype and food advertisement condition (P for interaction = 0.02), where the difference in consumption of a recently advertised food related to food advertisement exposure increased linearly with each additional FTO risk allele, even after controlling for BMI percentile. CONCLUSIONS Food advertisement exposure was associated with greater caloric consumption of a recently advertised food, and this effect was modified by an FTO genotype. Future research is needed to understand the neurological mechanism underlying these associations.

The aim of this study was to assess film character portrayals of tobacco and alcohol use in US and nationally-produced films that were popular in Argentina and Mexico from 2004–2012. We performed a content analysis of these films (n = 82 Argentine, 91 Mexican, and 908 US films, respectively). Chi-squares and t-tests were used to compare characteristics of characters who smoked or drank by country of movie production. Then data from all countries were pooled, and generalized estimating equation (GEE) models were used to determine independent correlates of character smoking or drinking. There were 480 major characters for Argentine-, 364 for Mexican-, and 4962 for US-produced films. Smoking prevalence among movie characters was similar to population smoking prevalence in Mexico (21%) and Argentina (26%), but about half in the US (11%), where movie product placements are restricted. Movie smoking declined over the period in all three countries. Movie alcohol prevalence was 40–50% across all countries and did not change with time. Demographic predictors of character smoking included: being male, 18 and older, having negative character valence. Movie smoking was not associated with lower SES. Predictors of character drinking included: being age 18 and older and positive character valence. Smoking and drinking predicted each other, illicit drug use, and higher scores for other risk behaviors. This suggests that policy development in Mexico and Argentina may be necessary to reduce the amount of character tobacco and alcohol use in films.

AIMS: To test whether exposure to party-related alcohol advertising is associated with drinking behavior in a national US sample of adolescents and young adults, independently of exposure to other alcohol advertising. DESIGN: Longitudinal telephone- and web-based surveys conducted in 2011 and 2013. SETTING: All regions of the United States, participants selected via mixed-mode random-digit-dial landline and cellphone frames. PARTICIPANTS: A sample of 2541 respondents with a mean age of 18.1 years (51.6% female) of which 1053 (41%) never had a whole drink of alcohol and 1727 (67%) never had six or more drinks during one drinking occasion. MEASUREMENTS: Outcome measures were onset of alcohol use and binge drinking during the study interval. Primary predictor was exposure to television alcohol advertising, operationalized as contact frequency and brand recall for 20 randomly selected alcohol advertisements. Independent post-hoc analyses classified all ads as "party" or "non-party" ads. Sociodemographics, sensation seeking, alcohol expectancies, and alcohol use of friends and family were assessed as covariates. FINDINGS: Onset rates for having the first whole drink of alcohol and for first binge drinking were 49.2% and 29.5%, respectively. On average, about half (M = 10.2) of the 20 alcohol advertisements in each individual survey were "party" ads. If both types of exposures ("party" and "non-party") were included in the regression model, only "party" exposure remained a significant predictor of alcohol use onset (AOR = 19.17; 95%CI 3.72-98.79) and binge drinking onset (AOR = 3.87; 95%CI 1.07-13.99) after covariate control. CONCLUSIONS: Adolescents and young adults in the USA appear to have higher rates of alcohol use and binge drinking onset if they have higher exposure to alcohol advertisements using a partying theme, independently of the amount of exposure to alcohol advertisements with non-party themes.This article is protected by copyright. All rights reserved. Language: en

Background This paper describes the methods and conceptual framework for Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study data collection. The National Institutes of Health, through the National Institute on Drug Abuse, is partnering with the Food and Drug Administration9s (FDA) Center for Tobacco Products to conduct the PATH Study under a contract with Westat. Methods The PATH Study is a nationally representative, longitudinal cohort study of 45 971 adults and youth in the USA, aged 12 years and older. Wave 1 was conducted from 12 September 2013 to 15 December 2014 using Audio Computer-Assisted Self-Interviewing to collect information on tobacco-use patterns, risk perceptions and attitudes towards current and newly emerging tobacco products, tobacco initiation, cessation, relapse behaviours and health outcomes. The PATH Study9s design allows for the longitudinal assessment of patterns of use of a spectrum of tobacco products, including initiation, cessation, relapse and transitions between products, as well as factors associated with use patterns. Additionally, the PATH Study collects biospecimens from consenting adults aged 18 years and older and measures biomarkers of exposure and potential harm related to tobacco use. Conclusions The cumulative, population-based data generated over time by the PATH Study will contribute to the evidence base to inform FDA9s regulatory mission under the Family Smoking Prevention and Tobacco Control Act and efforts to reduce the Nation9s burden of tobacco-related death and disease.

Introduction Up to 75% of people with serious mental illness (SMI) smoke, and most are highly dependent on nicotine, consuming more cigarettes per day than smokers without mental illness. Even with evidence-based treatment, relapses are common, resulting in high morbidity and early mortality from tobacco-related diseases. Electronic cigarettes (e-cigarettes) are theoretically safer because they deliver no tar or carbon monoxide; however, their appeal is largely untested in people with SMI. Methods We enrolled 21 chronic smokers with SMI who had failed a quit attempt and were not engaged in cessation treatment. Research staff provided e-cigarettes and instructions on how to use them, and assessed participants weekly for 4 weeks. Results Of the enrolled participants, 19 completed weekly assessments. From baseline to the final study visit, mean self-reported use of combustible tobacco declined from 192 to 67 cigarettes/week (t = 3.62, df = 17, p = 0.005), confirmed by reduction in breath carbon monoxide from 27 ppm to 15 ppm (t = 3.246, df = 18, p = 0.004). Use of e-cigarettes did not escalate over the 4 weeks. Temporary and mild side effects, including dry/sore throat, nausea, dizziness, and cough, were reported by 58% of participants. End of trial ratings of enjoyment, satisfaction compared to regular cigarettes, and willingness to buy e-cigarettes were high (ranging from 3.82–4.51 on a 5-point scale). Conclusions Results of this study suggest that people with SMI may find e-cigarettes an appealing substitute for combustible cigarettes. We found no evidence of increasing nicotine dependence. Further randomized studies are needed to better assess e-cigarette appeal and toxicity.

Background Use of flavour capsule varieties (FCVs) of cigarettes has rapidly increased in many countries. Adolescents are attracted to flavours; yet, surprisingly, no quantitative study has explored adolescents9 perceptions of these products. Objective To characterise the appeal of FCVs for young adolescents in Mexico. Methods In 2015, surveys were conducted with a representative sample of Mexican middle school students (n=10 124; ages 11–16 years; mean 12.4 years). Students viewed and rated packs for FCVs and non-FCVs from major brands (Marlboro, Camel, Pall Mall), with brand names removed. For each pack, students were asked to write the brand name (ie, brand recall), to evaluate pack attractiveness, and to indicate the pack they were most interested in trying (including a ‘none’ option). Logistic generalised estimating equation (GEE) models regressed brand recall, pack attractiveness and interest in trying on brand and FCV (yes vs no), controlling for sociodemographics and smoking risk factors. Results Marlboro regular, Camel regular, Camel light and Pall Mall FCVs were most often recalled (25%, 17%, 9%, 8%). Packs for Pall Mall FCVs and Camel FCVs were most often rated as very attractive (13%, 9%, respectively) and of interest for trial (22%, 13%) along with Marlboro regular (14%). In GEE models, FCVs were independently associated with greater attractiveness (adjusted OR (AOR)=1.83, 95% CI 1.72 to 1.94) and interest in trying (AOR=1.74, 95% CI 1.54 to 1.96). Perceived pack attractiveness was also independently associated with greater interest in trying (AOR=5.63, 95% CI 4.74 to 6.68). Conclusions FCVs appear to be generating even greater appeal among young adolescents than established non-FCVs in dominant brand families.

espanolIntroduccion: el tabaquismo en peliculas promueve el inicio de tabaquismo en adolescentes Objetivo: estimar el nivel de exposicion a imagenes de tabaco contenidas en peliculas vistas por adolescentes de Argentina y Mexico Metodos: Se realizo una encuesta a alumnos de primer ano del secundario de Argentina y Mexico. Se analizaron las 100 peliculas con mayor recaudacion en cada ano del periodo 2009-2013 (Argentina) y 2010-2014 (Mexico). A cada participante se le asigno una muestra aleatoria de 50 de estas peliculas, preguntandosele si la habia visto. Se estimo el numero total de adolescentes que habian visto cada pelicula en cada pais, y se multiplico por el numero de escenas que contenian tabaco (ocurrencias) en cada pelicula para asi obtener el numero de impresiones crudas de tabaco vista por los adolescentes escolarizados de cada pais. Resultados: Se analizaron 422 films en Argentina y 433 en Mexico. Mas de 500 millones de imagenes de tabaco fueron vistas por la poblacion joven de cada pais, lo que promedia 128 y 121 minutos de escenas con tabaquismo por cada adolescente en Argentina y Mexico respectivamente. Si bien los films calificados para mayores de 15/16/18 anos tenian mayor promedio por pelicula de escenas de tabaco, las peliculas calificadas para menores de esta edad fueron responsables de la mayor cantidad de escenas de tabaquismo vistas por adolescentes (67,3% en Argentina y 54,4% en Mexico) debido a su mayor audiencia. Conclusiones: A nivel poblacional son las peliculas para ninos las maximas responsables de la carga de tabaco vista por adolescentes. EnglishBackground: Smoking scenes in movies promote adolescent smoking onset; thus, the analysis of the number of smoking images inmovies really reaching adolescents has become a subject of increasing interest.Objective: The aim of this study was to estimate the level of exposure to images of smoking in movies watched by adolescents in Argentina and Mexico.Methods: First-year secondary school students from Argentina and Mexico were surveyed. One hundred highest-grossing films from each year of the period 2009-2013 (Argentina) and 2010-2014 (Mexico) were analyzed. Each participant was assigned a random sampleof 50 of these movies and was asked if he/she had watched them. The total number of adolescents who had watched each movie ineach country was estimated and was multiplied by the number of smoking scenes (occurrences) in each movie to obtain the numberof gross smoking impressions seen by secondary school adolescents from each country.Results: Four-hundred and twenty-two movies were analyzed in Argentina and 433 in Mexico. Exposure to more than 500 million smoking impressions was estimated for adolescents in each country, averaging 128 and 121 minutes of smoking scenes seen by each Argentine and Mexican adolescent, respectively. Although 15, 16 and 18-rated movies had more smoking scenes in average, moviesrated for younger teenagers were responsible for the highest number of smoking scenes watched by students (67.3% in Argentinaand 54.4% in Mexico) due to their larger audience.Conclusion: At the population level, movies aimed at children are responsible for the highest tobacco burden seen by adolescents.

Objective To assess the independent relation between parental restrictions on mature-rated media (M-RM) and substance use among South American adolescents. Methods Cross-sectional school-based youth survey of 3,172 students (mean age, 12.8 years; 57.6% boys) in 3 large Argentinean cities. The anonymous survey queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Adolescents reported M-RM restriction for internet and video game use, television programming, and movies rated for adults. Multivariate logistic regression models were used to assess the association between parental M-RM restriction and substance use after adjustment for hourly media use, measures of authoritative parenting style, sociodemographic characteristics, and sensation-seeking. Results Substance use rates were 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking, and 8% for illicit drug use (marijuana or cocaine). Half of the respondents reported parental M-RM restriction (internet 52%, TV 43%, adult movies 34%, video game 25%). Parental M-RM restriction was only modestly correlated with authoritative parenting measures. In multivariate analyses M-RM restriction on all 4 venues was strongly protective for all substance use outcomes. Compared with no restriction, odds ratios for substance use for full restrictions were 0.32 (0.18–0.59), 0.53 (0.38–0.07), 0.36 (0.22–0.59), and 0.49 (0.26–0.92) for current smoking, drinking, binge drinking, and illicit drug use, respectively. The most important single M-RM venue was movies. Conclusions Results of this study confirmed the protective association between parental M-RM restriction during adolescence and multiple substance use outcomes, including illicit drugs. M-RM restriction is independent of traditional parenting measures. The preponderance of the evidence supports intervention development.

Purpose Assess the prevalence and correlates of e-cigarette perceptions and trial among adolescents in Mexico, where e-cigarettes are banned. Methods Cross-sectional data were collected in 2015 from a representative sample of middle-school students (n = 10,146). Prevalence of e-cigarette awareness, relative harm, and trial were estimated, adjusting for sampling weights and school-level clustering. Multilevel logistic regression models adjusted for school-level clustering to assess correlates of e-cigarette awareness and trial. Finally, students who had tried only e-cigarettes were compared with students who had tried: (1) conventional cigarettes only; (2) both e-cigarettes and conventional cigarettes (dual triers); and (3) neither cigarette type (never triers). Results Fifty-one percent of students had heard about e-cigarettes, 19% believed e-cigarettes were less harmful than conventional cigarettes, and 10% had tried them. Independent correlates of e-cigarette awareness and trial included established risk factors for smoking, as well as technophilia (i.e., use of more media technologies) and greater Internet tobacco advertising exposure. Exclusive e-cigarette triers (4%) had significantly higher technophilia, bedroom Internet access, and Internet tobacco advertising exposure compared to conventional cigarette triers (19%) and never triers (71%) but not compared to dual triers (6%), although dual triers had significantly stronger conventional cigarette risk factors. Conclusions This study suggests that adolescent e-cigarette awareness and use is high in Mexico, in spite of its e-cigarette ban. A significant number of medium-risk youth have tried e-cigarettes only, suggesting that e-cigarettes could lead to more intensive substance use. Strategies to reduce e-cigarette use should consider reducing exposures to Internet marketing.

Objective To compare how smoking was depicted in Hollywood movies before and after an intervention limiting paid product placement for cigarette brands. Design Correlational analysis. Setting/Participants Top box office hits released in the USA primarily between 1988 and 2011 (n=2134). Intervention The Master Settlement Agreement (MSA), implemented in 1998. Main outcome measures This study analyses trends for whether or not movies depicted smoking, and among movies with smoking, counts for character smoking scenes and average smoking scene duration. Results There was no detectable trend for any measure prior to the MSA. In 1999, 79% of movies contained smoking, and movies with smoking contained 8 scenes of character smoking, with the average duration of a character smoking scene being 81 s. After the MSA, there were significant negative post-MSA changes (p

Importance Success in reducing the prevalence of adolescent smoking could reflect complete prevention of smoking initiation or a shift in the age of cigarette smoking initiation from adolescence into early adulthood. Objective To assess trends in early adult (ages 18-23 years) vs adolescent (age

Introduction The tobacco industry has previously targeted sexual/gender and racial/ethnic minorities with focused campaigns in traditional, offline marketing. We assess whether these populations report more engagement with online tobacco marketing compared with heterosexual and non-Hispanic white youth. Methods Data were from 8015 adolescents sampled between 2014 and 2015 in the nationally-representative Population Assessment for Tobacco and Health (PATH) Study. Engagement with online tobacco marketing within the past year was assessed through eight forms of engagement. A weighted logistic regression model was fit with engagement as outcome and socio-demographic and psychosocial characteristics, internet-related and substance use behavior, tobacco-related risk factors, tobacco use status, and prior engagement with online tobacco marketing as covariates. Results Accounting for other covariates including tobacco use status and prior engagement with online tobacco marketing, the odds of past-year engagement were higher for sexual minority males (aOR = 1.57; 95% CI: 1.05–2.35) compared to straight males and higher for sexual minority females (aOR = 1.45; 95% CI: 1.13–1.87) compared to straight females. The odds of past-year engagement were also higher for Hispanics (aOR = 1.31; 95% CI: 1.11–1.56) and non-Hispanic Blacks (aOR = 1.42; 95% CI: 1.14–1.77) compared to non-Hispanic Whites. Conclusions Sexual/gender and and racial/ethnic minority youth reported higher engagement with online tobacco marketing than their heterosexual and non-Hispanic white peers, respectively.