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Background: Electronic (e-)cigarettes may help adult cigarette smokers achieve cigarette cessation, depending on patterns of e-cigarette use. Among cigarette smokers who do not use e-cigarettes, it is unclear if and how a-priori intentions for use are related to uptake patterns. Longitudinal studies have focused on established e-cigarette users or adolescent and young adult populations exclusively., Methods: Within a nationwide randomized clinical trial (N = 638), adult cigarette smokers not currently using e-cigarettes were randomized (2:1) to receive (or not) one-month sampling of e-cigarettes. An exploratory factor analysis (EFA) was performed on an established 15-item measure assessing a-priori intentions for e-cigarette use to identify latent variables. Among those receiving e-cigarette products, regression models examined relationships between intentions and: 1) uptake (yes/no), 2) frequency (number of days per week), and 3) amount (puffing episodes per day) of e-cigarette use at one-month follow-up., Results: Two factors emerged from the EFA: 1) cigarette-related intentions (e.g., cigarette cessation, no smell) and 2) novel appeal of e-cigarettes (e.g., flavors). Three items remained and were treated as separate intentions: "feels like cigarette smoking", "curiosity", and "affordability". In the final multivariable models, "feel like cigarette smoking" predicted more frequent e-cigarette use (β = 0.187, SE = 0.086, p = 0.03); however, none of the five factors/intentions were significantly associated with uptake or amount of use., Conclusions: For adult cigarette smokers not currently using e-cigarettes, a-priori intentions for using e-cigarettes might not be predictive of if or how these products will be used in the future, suggesting that motives may not drive use behavior., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The proposed FDA product standard to prohibit menthol as a characterizing flavor in combustible cigarettes has the potential to significantly reduce tobacco-related health disparities. Whether a menthol e-liquid product standard would improve or hinder public health is unknown. No known research has directly examined the impact of menthol vs. tobacco flavored e-liquid use on acute e-cigarette use patterns, subjective experience, behavioral intentions, and craving and withdrawal among menthol cigarette smokers., Methods: Black (n = 47) and White (n = 4) nicotine-deprived menthol smokers with limited e-cigarette experience completed two counterbalanced in-laboratory 30-minute ad libitum vaping sessions with menthol and tobacco nicotine salt-based e-liquid in a randomized crossover pilot trial design. Questionnaires assessed reductions in craving and withdrawal and post-session subjective experience and behavioral intentions. Puff topography was measured continuously throughout each vaping session., Results: Measures of puff topography did not differ significantly by e-liquid flavor (all p > .40). Similarly, menthol and tobacco flavored e-cigarettes were both rated positively in terms of subjective effects and behavioral intentions (all p > .10) and about 40 % of participants reported a preference for the tobacco-flavored e-liquid. Finally, participants showed comparable reductions in craving (p = .210) and withdrawal (p = .671) from pre- and post-session regardless of e-liquid flavor., Conclusions: Among menthol smokers in a lab-based setting, findings suggest that menthol vs tobacco e-liquid flavor has little impact on acute changes in puff patterns, subjective experience, behavioral intentions, or craving and withdrawal., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: E-cigarettes and heated tobacco products (HTPs) may serve as potential options for harm reduction for smokers if they possess reward profiles similar to cigarettes. Little is known about the abuse liability of HTPs and e-cigarettes versus cigarettes in racial/ethnic minority smokers., Aims and Methods: Twenty-two nicotine-deprived people who smoke (black [n = 12] and white [n = 10]) completed three visits that included a standardized 10-puff bout followed by a 50-minute ad libitum use assessment with their usual brand cigarette (UBC), an e-cigarette, and HTP. Visits were completed in a randomized crossover design and were separated by a minimum 48-hour washout period. Assessments included plasma nicotine, Cmax, and reductions in craving and withdrawal., Results: UBC delivered significantly greater levels of nicotine compared to the e-cigarette (p < .001) and HTP (p < .01) during both the standardized and ad libitum sessions. HTP delivered more nicotine than the e-cigarette during the standardized puffing session (p = .047) but not the ad libitum session. Only craving during the standardized puffing session and not the ad libitum session showed significant differences across products (p < .001) such that UBC resulted in the greatest reduction followed by HTP and e-cigarette., Conclusions: Despite greater nicotine delivery from the UBC compared to e-cigarette and HTP, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use., Implications: Use of participant's UBCs (UBC) resulted in greater nicotine delivery compared to both the e-cigarette and HTP. Despite this relative difference in nicotine delivery, participants reported reductions in craving and withdrawal across products, particularly following ad libitum use. These findings suggest that in this sample of black and white people who smoke, HTPs and e-cigarettes provided significant relief from negative symptoms that maintain smoking., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: As the US Food and Drug Administration takes regulatory action on menthol cigarettes, debate continues about how restricting menthol e-liquids might impact adult menthol smokers in switching to e-cigarettes., Methods: Switching patterns and e-cigarette acceptability were assessed at week 6 among 64 black and Latinx menthol cigarette smokers who used JUUL menthol (n=39) or non-menthol e-cigarettes ((n=25), primarily mint or mango) as part of a randomised switching trial., Results: No clear evidence of effects was found between menthol versus non-menthol e-cigarettes on use or subjective effects/acceptability, effect sizes for all comparisons were small (effect size=0.0-0.2), and Bayes factor ranged from 0.10 to 0.15. Specifically, 82.1% of participants who used menthol-flavoured e-cigarettes fully or partially switched to e-cigarettes compared with 88.0% of participants who used a non-menthol (p=0.75). Further, both groups demonstrated substantial reductions in cigarettes per day (menthol e-cigarettes: -8.5±10.4 vs non-menthol e-cigarettes: -8.8±5.8, p=0.87), comparable grams of e-liquid consumed (menthol e-cigarettes: 9.2±9.8 g vs non-menthol e-cigarettes: 11.0±11.0 g, p=0.47), and positive subjective effects, including 'just right' throat hit (menthol e-cigarettes: 70.7% vs non-menthol e-cigarettes: 66.7%, p=0.93) and flavour liking (menthol e-cigarettes: 75.6% vs non-menthol e-cigarettes: 66.7%, p=0.32)., Conclusions: Both menthol and non-menthol e-cigarettes were associated with high rates of use and acceptability among menthol smokers. Findings require confirmation in a fully powered non-inferiority or equivalence study but provide preliminary evidence to inform regulatory action on menthol e-cigarettes that could slow youth initiation without impacting black and Latinx menthol cigarette smokers interested in switching to e-cigarettes., Trial Registration Number: NCT03511001., Competing Interests: Competing interests: JA received sponsored funds for travel expenses as a speaker for the 2021 annual GTNF conference. He also serves as a consultant, and has equity, in a start-up company Respira Technologies., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Alternative nicotine delivery products, including electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs), contain fewer toxicants than combustible cigarettes and offer a potential for harm reduction. Research on the substitutability of e-cigarettes and HTPs is crucial for understanding their impact on public health. This study examined subjective and behavioral preferences for an e-cigarette and HTP relative to participants' usual brand combustible cigarette (UBC) in African American and White smokers naïve to alternative products., Aims and Methods: Twenty-two adult African American (n = 12) and White (n = 10) smokers completed randomized study sessions with their UBC and study provided e-cigarette and HTP. A concurrent choice task allowed participants to earn puffs of the products but placed UBC on a progressive ratio schedule, making puffs harder to earn, and e-cigarette and HTP on a fixed ratio schedule to assess behavioral preference for the products. Behavioral preference was then compared to self-reported subjective preference., Results: Most participants had a subjective preference for UBC (n = 11, 52.4%), followed by an equal preference for e-cigarette (n = 5, 23.8%) and HTP (n = 5, 23.8%). During the concurrent choice task, participants showed a behavioral preference (i.e., more earned puffs) for the e-cigarette (n = 9, 42.9%), followed by HTP (n = 8, 38.1%), and UBC (n = 4, 19.1%). Participants earned significantly more puffs of the alternative products compared to UBC (p = .011) with no difference in earned puffs between e-cigarettes and HTP (p = .806)., Conclusions: In a simulated lab setting, African American and White smokers were willing to substitute UBC for an e-cigarette or HTP when the attainment of UBC became more difficult., Trial Registration: NCT04646668., Implications: Findings suggest that African American and White smokers are willing to substitute their UBC for an alternative nicotine delivery product (e-cigarette or HTP) when the attainment of cigarettes became more difficult in a simulated lab setting. Findings require confirmation among a larger sample under real-world conditions but add to growing evidence suggesting the acceptability of alternative nicotine delivery products among racially diverse smokers. These data are important as policies that limit the availability or appeal of combustible cigarettes are considered or enacted., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The present study developed a measure assessing the emotional responses, "Displacement Imposition," of cigarette and e-cigarette users on a college campus with a smoking/vaping ban. It also examined the relationship between Displacement Imposition and readiness to quit smoking/vaping, and how this relationship differed between cigarette and e-cigarette users., Participants: Participants (N = 297) were from a large, Midwestern university., Methods: Participants completed online questionnaires assessing demographics, cigarette and e-cigarette use, Displacement Imposition , and readiness to quit., Results: All six Displacement Imposition items loaded onto a single factor. A significant interaction emerged between Displacement Imposition and product use in predicting readiness to quit. At high levels of Displacement Imposition , cigarette users were less ready to quit than e-cigarette users., Conclusions: Findings suggest restrictions imposed on cigarette and e-cigarette users were associated with reduced readiness to quit. Findings inform tobacco control policies as tobacco denormalization may increase the burden placed on tobacco users.

Importance: Adapting to different smoking cessation medications when an individual has not stopped smoking has shown promise, but efficacy has not been tested in racial and ethnic minority individuals who smoke and tend to have less success in quitting and bear a disproportionate share of tobacco-related morbidity and mortality., Objective: To evaluate efficacy of multiple smoking cessation pharmacotherapy adaptations based on treatment response in Black adults who smoke daily., Design, Setting, and Participants: This randomized clinical trial of adapted therapy (ADT) or enhanced usual care (UC) included non-Hispanic Black adults who smoke and was conducted from May 2019 to January 2022 at a federally qualified health center in Kansas City, Missouri. Data analysis took place from March 2022 to January 2023., Interventions: Both groups received 18 weeks of pharmacotherapy with long-term follow-up through week 26. The ADT group consisted of 196 individuals who received a nicotine patch (NP) and up to 2 pharmacotherapy adaptations, with a first switch to varenicline at week 2 and, if needed, a second switch to bupropion plus NP (bupropion + NP) based on carbon monoxide (CO)-verified smoking status (CO ≥6 ppm) at week 6. The UC group consisted of 196 individuals who received NP throughout the duration of treatment., Main Outcomes and Measures: Anabasine-verified and anatabine-verified point-prevalence abstinence at week 12 (primary end point) and weeks 18 and 26 (secondary end points). The χ2 test was used to compare verified abstinence at week 12 (primary end point) and weeks 18 and 26 (secondary end points) between ADT and UC. A post hoc sensitivity analysis of smoking abstinence at week 12 was performed with multiple imputation using a monotone logistic regression with treatment and gender as covariates to impute the missing data., Results: Among 392 participants who were enrolled (mean [SD] age, 53 [11.6] years; 224 [57%] female; 186 [47%] ≤ 100% federal poverty level; mean [SD] 13 [12.4] cigarettes per day), 324 (83%) completed the trial. Overall, 196 individuals were randomized to each study group. Using intent-to-treat and imputing missing data as participants who smoke, verified 7-day abstinence was not significantly different by treatment group at 12 weeks (ADT: 34 of 196 [17.4%]; UC: 23 of 196 [11.7%]; odds ratio [OR], 1.58; 95% CI, 0.89-2.80; P = .12), 18 weeks (ADT: 32 of 196 [16.3%]; UC: 31 of 196 [15.8%]; OR, 1.04; 95% CI, 0.61-1.78; P = .89), and 26 weeks (ADT: 24 of 196 [12.2%]; UC: 26 of 196 [13.3%]; OR, 0.91; 95% CI, 0.50-1.65; P = .76). Of the ADT participants who received pharmacotherapy adaptations (135/188 [71.8%]), 11 of 135 (8.1%) were abstinent at week 12. Controlling for treatment, individuals who responded to treatment and had CO-verified abstinence at week 2 had 4.6 times greater odds of being abstinent at week 12 (37 of 129 [28.7%] abstinence) than those who did not respond to treatment (19 of 245 [7.8%] abstinence; OR; 4.6; 95% CI, 2.5-8.6; P < .001)., Conclusions and Relevance: In this randomized clinical trial of adapted vs standard of care pharmacotherapy, adaptation to varenicline and/or bupropion + NP after failure of NP monotherapy did not significantly improve abstinence rates for Black adults who smoke relative to those who continued treatment with NP. Those who achieved abstinence in the first 2 weeks of the study were significantly more likely to achieve later abstinence, highlighting early treatment response as an important area for preemptive intervention., Trial Registration: ClinicalTrials.gov Identifier: NCT03897439.

Introduction: Heated tobacco products (HTPs) share similar characteristics as combustible cigarettes and electronic nicotine delivery systems (ENDS) and thus may serve as cues for smoking and vaping. While HTP familiarity is low in the United States, HTPs may be perceived as a less harmful alternative to cigarettes., Aims and Methods: The present study examined if visual exposure to HTP use influenced cigarette and e-cigarette craving in a large national sample of adults with varied smoking patterns. Current, former, and never cigarette smokers (N = 515; Mage = 40) were recruited from online crowd-sourcing panels throughout the United States from January to April 2020. Participants completed surveys before and after watching a video depicting the use of an HTP, cigarette, or bottled water. Main outcomes were changes in cigarette craving after exposure to the video cue. Secondary outcomes included changes in e-cigarette craving., Results: Relative to the water cue, the HTP and cigarette cues increased cigarette craving in current smokers. The HTP cue also increased e-cigarette craving (desire for a mod or vape pen and JUUL) across all subgroups., Conclusions: Current smokers demonstrated cue reactivity to the use of an HTP as they reported increases in both cigarette and e-cigarette craving after exposure. All smoking groups reported e-cigarette reactivity to the HTP cue. As HTPs gain traction globally, it is crucial to consider how their use may influence active users and passive viewers to inform future health policies., Implications: Noncombustible nicotine delivery systems are known cues for cigarette smoking and e-cigarette vaping, and this study examined whether relatively novel heated tobacco products (HTPs) may also act as a smoking or vaping cue in adults across varied smoking backgrounds. Results showed that passive exposure to HTP use increased desire for both a cigarette and an e-cigarette in current smokers and also increased desire for an e-cigarette in former and nonsmokers. Thus given its similarity to smoking and vaping, HTP use may affect passive observers and could play a role in perpetuating the dual use of cigarettes and vape products., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Trends in knowledge and beliefs about e-cigarette (EC) harm have been changing. Our study examined whether change in risk perception of ECs predicts cigarettes smoked per week (CPW) among Black and Latinx individuals who smoke enrolled in an EC switching randomized clinical trial (RCT)., Methods: We analyzed data from one arm of a 6-week EC RCT of individuals who smoke attempting to switch to nicotine salt pod system ECs (n = 110; Black, n = 57; Latinx, n = 53). Our explanatory variable was change in risk perception of ECs compared to combustible cigarettes (CC) from baseline to week 6. Our outcome was CPW measured by a 7-day timeline follow-back interview. A negative binomial GEE model was conducted to examine the association between risk perception and CPW at baseline and week 6., Results: The mean CPW decreased from 82.8 (SD=49.8) at baseline to 15.8 (SD=29.8) at week 6. A one-level increase in EC risk perception (i.e., EC perceived as riskier than CC from baseline to week 6) was associated with an increase in CPW (IRR: 1.83, 95% CI: 1.03; 3.24). Latinx participants were more likely to have higher CPW as EC risk perception increased compared to Black participants (IRR=1.89, 95% CI: 1.09; 3.26)., Conclusion: We found that CPW at week 6 was significantly higher as change in risk perception of EC relative to CC increased. Given the influence of risk perception on smoking behavior, people who smoke should be educated on the benefits and harms of ECs., Competing Interests: Declaration of Competing Interest Dr. Ahluwalia received sponsored funds for travel expenses as a speaker for the 2021 annual GTNF conference. Dr. Ahluwalia serves as a consultant and has equity in a start-up company Qnovia, formerly known as Respira Technologies., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Schools remain at the frontlines of addressing issues, such as e-cigarette use, that impact students. Despite e-cigarette use remaining a significant public health concern in the U.S., schools have limited resources (e.g., staff, capacity, programming) to address it, especially in rural and frontier areas. This ECHO Pilot Project aimed to build capacity and equip schools and school staff in the state of Kansas to address high rates of youth e-cigarette use by providing prevention support and information on best practices for e-cigarette cessation., Methods and Analysis: The pilot used the established Project ECHO model to disseminate evidence-based strategies for e-cigarette prevention and cessation among youth to schools across Kansas. The pilot selected 20 interdisciplinary school teams representing both rural and urban middle and high schools across the state to participate in seven ECHO sessions. ECHO sessions proceeded throughout Fall 2021, with the final session in Spring 2022. School participants completed pre-post surveys as well as component-specific surveys following each ECHO session. In addition, each school team created an individualized action plan to comprehensively address e-cigarette use at their school based on the information provided throughout the ECHO. Survey data, school tobacco/nicotine policies, and action plans will be analyzed to assess process and final outcomes., Discussion: If successful, this pilot will demonstrate that the ECHO model is an effective platform for building school staff knowledge and skills to implement evidence-based strategies in both urban and rural settings. It is anticipated that the pilot will build capacity and equip schools and school staff to address high rates of youth e-cigarette use by providing support for school-based prevention programs and referrals for e-cigarette cessation which will lessen the burden of nicotine-related problems in Kansas schools and communities. Finally, the pilot will provide evidence that the ECHO model can be successfully and equitably applied in a school setting and may be a viable method for addressing other public health-related issues faced by schools., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Leavens, Roberts, Faseru, Thompson, Denes-Collar and Shah.)

Introduction: Flavourants and humectants in waterpipe tobacco (WT) increase product appeal. Removal of these constituents, however, is associated with increased intensity of WT puffing, likely due to reduced nicotine delivery efficiency. To clarify the potential public health outcomes of restrictions on flavourants or humectants in WT, we evaluated the effects of these constituents on puffing behaviours, biomarkers of exposure and subjective effects among adults with high versus low WT dependence., Methods: N=39 high dependence and N=49 low dependence WT smokers (Lebanese Waterpipe Dependence Scale scores > 10 = high dependence) completed four smoking sessions in a cross-over experiment. Conditions were preferred flavour with humectant (+F+H), preferred flavour without humectant (+F-H), unflavoured with humectant (-F+H) and unflavoured without humectant (-F-H). Measures of puff topography, plasma nicotine and expired carbon monoxide (eCO) boost, and subjective effects were assessed., Results: Level of WT dependence modified the effect of WT condition on average flow rate, average puff volume and eCO boost. Although, overall, participants puffed the +F+H WT least intensely and -F-H WT most intensely, this association was strongest among WT smokers with high dependence. Participants preferred smoking the +F+H WT and achieved the largest plasma nicotine boost in that condition., Discussion: Findings underscore the complexity of setting product standards related to flavourants and humectants in WT. Future research evaluating whether WT smokers with high dependence would quit or reduce their WT smoking in response to removal of flavourants or humectants from WT is necessary to appreciate the full public health effects of such policies., Competing Interests: Competing interests: TE and AS are paid consultants in litigation against the tobacco industry and also the electronic cigarette industry and are named on a patent for a device that measures the puffing behaviour of electronic cigarette smokers. The other authors have no interests to disclose., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aims: For electronic cigarettes (e-cigarettes) to be a viable substitute for combustible cigarettes, it is likely that they must be rewarding enough for regular use, indicated by factors such as craving and dependence, important aspects of reinforcement. This study aimed to understand short-term changes in measures of nicotine dependence between groups differing by use trajectory in a switching trial, and within group changes of these measures., Design: Secondary data analysis of one arm of an e-cigarette randomized clinical trial., Setting: San Diego, California and Kansas City, Missouri, United States., Participants: 114 African American (n = 60) and Latinx (n = 54) smokers (58.8% male) attempting to switch to nicotine salt pod system (NSPS) e-cigarettes in a 6-week trial., Measurements: At week 6, participants were classified by use trajectory: exclusive smokers (n = 16), exclusive e-cigarette (n = 32), or dual users (n = 66). E-cigarette, cigarette, and total nicotine dependence (cigarette + e-cigarette), use patterns, cigarette craving and nicotine withdrawal, and cotinine were assessed at baseline and week 6 using standard measures., Findings: In between group comparisons, exclusive e-cigarette and dual users showed greater reductions in cigarette dependence (e-cigarette: -32.38, 95% CI = -37.7,-27.1; dual: -18.48, 95% CI = -22.2,-14.7), withdrawal (e-cigarette: -6.25, 95% CI = -8.52,-3.98; dual: -3.18, 95% CI = -5.02,-1.34), craving (e-cigarette: -11.44, 95% CI = -14.2,8.7; dual: -9.59, 95% CI = -11.6,-7.59), and cigarettes per day (CPD; e-cigarette: -11.19, 95% CI = -13.1,-9.27; dual: -9.39, 95% CI = -11.3, -7.52) compared with exclusive smokers. In within group analyses, e-cigarette and dual users showed reductions in craving and withdrawal from baseline to week 6. Exclusive e-cigarette and dual users, maintained cotinine levels (all Ps > 0.05) and showed reductions in CPD and cigarette dependence (all Ps < 0.01). Findings were inconclusive regarding changes in total nicotine dependence from baseline to week 6 among exclusive e-cigarette users (P = 0.123). Dual users showed increased total nicotine dependence (P < 0.001) and smokers showed decreased total dependence (P = 0.004)., Conclusions: Smokers who switch to nicotine salt pod system e-cigarettes maintain their nicotine levels and transfer their dependence, suggesting that nicotine salt pod system e-cigarettes have a similar reinforcement potential to cigarettes and facilitate switching., (© 2021 Society for the Study of Addiction.)

Using a checklist to establish patients' level of dependence and combining behavioral therapy with nicotine replacement products can help users to quit.

Introduction: Initiation of e-cigarette use by young adults is a significant public health issue within the debate on vaping. The current study is an exploratory evaluation of brief educational information among young adults and investigated outcomes as a function of JUUL use and smoking status., Methods: Participants (N = 947) were young adults (<30 years old) recruited from Amazon's Mechanical Turk based on smoking and JUUL use status. Participants completed baseline assessments, viewed a brief JUUL educational handout, and completed post-assessments., Results: There was a significant Time X Group interaction for JUUL-related knowledge (p < .001), with never JUUL/never smokers showing the greatest increase in knowledge. Brief education increased JUUL-related knowledge and risk perceptions and had a modest impact on commitment to quitting and readiness to quit JUUL (all p ≤ 0.001; ds = 0.06-0.74; time × group p > .05 for all contrasts except JUUL-related knowledge). Participants showed modest decreases in interest in future JUUL use, interest in purchasing, and interest in future regular use (all p ≤ 0.001; ds = 0.07-0.08; time × group p > .05 for all contrasts). In terms of smoking outcomes, participants reported reduced perceived harm to others (p < .001; d = 0.09) and decreased intentions to smoke regularly (p = .001; d = 0.07)., Conclusions: Brief education was effective in increasing knowledge and risk perceptions while showing a modest effect on intentions for future use. The information was most effective in increasing knowledge among non-users, suggesting that brief education may be useful for preventing initiation. Analysis of group differences suggest current JUUL use status is more important in informing JUUL-related attitudes than smoking status., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: To examine whether changes in select measures of e-cigarette puffing topography are associated with changes in smoking behavior., Methods: Sixteen current cigarette smokers were instructed to completely switch from smoking combustible cigarettes to using e-cigarettes over a 2-week period. The study was completed in the Southern Midwestern region of the United States. Measures included demographics, smoking history, and cigarette dependence, as well as baseline and 2-week follow-up self-reported cigarettes per day, cigarette craving and urges, exhaled carbon monoxide readings, and e-cigarette usage data (puff number, puffing time, and average puff duration) collected via the e-cigarette built-in puff counter., Results: Over the 2-week switching period, participants significantly reduced their cigarettes per day (~80% reduction, p < .0001). Although the number of e-cigarette puffs/day remained relatively stable (p > .05), the average total e-cigarette daily puffing time increased significantly (p = .001). Users' average puff duration increased by 91 ms/puff/d (p < .001). The percentage decrease in cigarettes smoked per day was significantly and directly related to the slope of subjects' average puff duration over time (r(13) = .62, p = .01), such that as cigarettes per day decreased, puff duration increased. Self-reported smoking urges remained relatively stable from baseline to the end of the 2-week period (p > .05)., Conclusions: Among smokers switching to an e-cigarette, greater increases in e-cigarette puff duration was associated with greater reductions in cigarette smoking., Implications: The current study is one of the first to examine changes in smokers' e-cigarette puffing behavior and associated changes in cigarette consumption as they attempt to completely switch to e-cigarettes. During a 2-week switching period, participants reduced their cigarettes per day. Moreover, although e-cigarette puffs per day remained relatively stable, users' average puff duration increased significantly. Greater increases in e-cigarette puff duration were associated with greater reductions in cigarette smoking. Understanding how to effectively use an e-cigarette to best reduce and eventually quit smoking will be necessary as smokers increasingly turn to these products to facilitate possible cessation., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness., Methods: Adults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer)., Results: Frequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes., Conclusions: During a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.

Electronic cigarette (e-cigarette) use continues to proliferate with fast-paced product evolution. Pod mod e-cigarettes emerged in the market in 2015 and have changed the tobacco landscape again. However, little is known regarding their addiction potential among users. The current study describes e-cigarette dependence and demand among pod mod users as a function of smoking status (current smokers/dual users, former smokers, and never smokers). Participants were 593 young adult ( M age = 25.9 years) JUUL users recruited via Amazon's Mechanical Turk. Respondents were specifically recruited based on current use of pod mods (but may also be using other e-cigarette devices) and smoking status (never, former, and current/dual users). Participants completed online measures assessing e-cigarette dependence and demand. Dual users of pod mods and cigarettes displayed greater e-cigarette dependence compared to current pod mod users with no history of cigarette smoking ( p = .033). Similarly, dual users showed the greatest levels of e-cigarette demand compared to both former smokers and those without a history of smoking ( p s < .05). Dual users displayed the greatest e-cigarette dependence and demand. Future research should directly assess potential mechanisms for this effect and continue to monitor e-cigarette dependence as the tobacco landscape changes with the emergence of new e-cigarette products and innovations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: Personalized normative alcohol feedback (PNF) is associated with decreased alcohol use among young adults. However, limited research has examined the influence of depressive symptoms on PNF efficacy. This study examined symptoms of depression as a moderator of college student response to a computerized PNF intervention for alcohol use., Methods: College students (N = 212, 59% female) who reported drinking in a typical week completed baseline and one-month assessments as part of a previously published intervention trial. We randomized participants to alcohol PNF (n = 153) or assessment only (n = 59). We used regression models to examine the interaction between PNF and symptoms of depression on alcohol outcomes at one-month follow-up., Results: One in four participants screened positive for clinically significant symptoms of depression. Depressive symptoms did not moderate intervention effects on drinking quantity. However, PNF was only associated with reduced frequency of heavy episodic drinking and lower probability of any alcohol-related consequence in the context of mild to moderate (not minimal) symptoms of depression., Conclusions: PNF is more effective than assessment alone in reducing drinking quantity, regardless of symptoms of depression. However, it may only be more effective in decreasing frequency of heavy episodic drinking and the probability of alcohol-related consequences among those experiencing mild to moderate (as opposed to minimal) symptoms of depression. Alcohol intervention trials should assess symptoms of depression and consider them in data analysis., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Monitoring trends and perceptions of new nicotine salt-based electronic cigarettes (ECs), like JUUL, is important to identify associations with product experimentation and use. Understanding harm perceptions of these new devices will inform prevention and intervention efforts. The current study assesses perceptions of the absolute harmfulness of JUUL use in addition to comparing it to other tobacco products., Methods: Participants ( N = 839, 52% male) reporting ever use of JUUL were recruited from Amazon's Mechanical Turk from January to March 2018. Respondents completed questionnaire items assessing demographics, co-use of non-JUUL products, JUUL use status (i.e., daily users (10.8%), non-daily users (29.4%), and triers (59.9%)), and JUUL and other tobacco products absolute harm perceptions., Results: Overall, participants rated JUUL as significantly less harmful than all other tobacco products ( p < 0.001), except other ECs. Daily JUUL users rated JUUL as less harmful compared to non-daily JUUL users and JUUL triers ( p < 0.05). JUUL was rated as more harmful by women compared to men ( p < 0.05)., Conclusions: Increased frequency of JUUL use was associated with decreased harm perceptions. JUUL was associated with reduced perceptions of absolute harm compared to most other tobacco products, except other ECs. Public health practitioners should develop public health interventions that increase harm perceptions of ECs.

Poor sleep health is associated with numerous health concerns, and sleep problems are exacerbated by cigarette smoking. Although rates of traditional tobacco use are declining, rates of electronic cigarette (e-cigarette) use are comparatively high and growing. Given that nicotine is a primary mechanism by which smoking negatively impacts sleep health, e-cigarette use may also be linked to poor sleep health; however, no research has investigated this association. Participants were 1,664 college students, 40.9% of whom reported ever trying or currently using an e-cigarette. Questionnaires assessed demographic information, sleep health and e-cigarette use status and patterns. All measures were completed remotely via a secure online survey. Analysis of covariance was used to compare the sleep health of daily/non-daily e-cigarette users to (a) non-users and (b) users of combustible cigarettes. Gender and drinks per week were included as covariates in analyses. Current combustible and e-cigarette users reported significantly more sleep difficulties than never users. Users of e-cigarettes reported greater use of sleep medication than combustible cigarette users. Similar to combustible cigarette smoking, e-cigarette use (vs. non-use) was associated with worse sleep health, even among non-daily e-cigarette users. These findings may indicate a need for assessment of and education on the role of e-cigarette use in sleep health among individuals who report experimentation with or current use of e-cigarettes. Future research should examine these relationships prospectively., (© 2019 European Sleep Research Society.)

Introduction: The present study examined how the lack of characterising flavours and low levels of humectants may affect users' waterpipe tobacco (WT) smoking topography, subjective effects, toxicant exposure and intentions for continued use., Methods: 89 WT smokers completed four ad libitum smoking sessions (characterising flavor/high humectant (+F+H); characterising flavor/low humectant (+F-H); no characterising flavor/high humectant (-F+H); no characterising flavor/low humectant (-F-H)) in a randomised cross-over design. WT was commercially available; same brand but nicotine levels were not held constant. A subsample (n=50) completed a standardised, 10-puff session preceding ad libitum smoking. Participants completed questionnaires, exhaled carbon monoxide (eCO) testing and provided blood samples for plasma nicotine. Smoking topography was measured throughout the session. Post hoc analyses showed that -F+H and -F-H did not differ significantly in humectant levels. Therefore, these groups were collapsed in analyses (-F-H)., Results: WT smokers reported significantly greater satisfaction, liking, enjoyment and greater intentions for continued use when smoking +F+H compared with other WT products, with -F-H receiving the lowest ratings. Significant differences in topography were observed during standardised and ad libitum sessions, with the -F-H preparation leading to greater total inhaled volume and eCO boost, but lower nicotine boost compared with +F+H (all p<0.05)., Discussion: The findings demonstrate the importance of flavours and humectants on improving WT smoking experience and increasing the likelihood that users will want to initiate and continue smoking. Moreover, it demonstrates that flavours and humectants influence smoking behaviour and toxicant exposure in some unexpected ways that are important for regulatory efforts., Competing Interests: Competing interests: TE is a paid consultant in litigation against the tobacco industry and the electronic cigarette industry, and is named on a patent for a device that measures the puffing behaviour of electronic cigarette users., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban ( n  = 792) and in fall 2014 ( n  = 310), 2015 ( n  = 208), and 2016 ( n  = 417). E-cigarette use increased in the years following the ban ( p  = .01) while combustible cigarette use decreased from 2013 to 2016 ( p  = .02). Men were more likely than women to use both products ( ps  < .05). Students' perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban ( p  > .05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.

Introduction: Personalized feedback interventions (PFIs) are associated with small but reliable decreases in alcohol consumption among college students. While they often include information regarding protective behavioral strategies (PBS), PFIs do not typically include feedback aimed to modify normative perceptions of PBS. This study aimed to enhance the efficacy of existing PFIs among college students by incorporating normative feedback on participants' use of PBS., Methods: Students enrolled in undergraduate courses (N = 268) completed baseline and 1-month follow-up assessments of past-month use of PBS, normative perceptions of PBS use, alcohol consumption, and alcohol-related consequences. Participants were randomized to one of three conditions: typical feedback on PBS (typical strategies PFI), descriptive normative feedback on PBS (strategy norms PFI), or assessment-only control (AOC). Participants in the typical strategies PFI and strategy norms PFI conditions received web-based personalized feedback profiles., Results: Compared to AOC, both the strategy norms PFI and typical strategies PFI were effective in correcting participants' perceptions of other students' engagement in PBS (p = .01) but did not differ significantly from one another. No statistically significant differences were observed between conditions in terms of actual PBS use, alcohol consumption, or alcohol-related consequences at 1-month follow-up (p > .05)., Discussion: The strategy norms and typical strategies PFIs were both successful in increasing normative perceptions of PBS use, indicating that general (rather than normative) feedback regarding PBS use may be sufficient for changing perceptions of PBS use., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: Minimally regulated electronic cigarettes (e-cigarette) advertising may be one potential factor driving the increasing prevalence of young adult e-cigarette use. Using eye-tracking, the current study examined which e-cigarette advertising features were the most appealing to young adults as a first step to examine how e-cigarette advertising may be regulated., Methods: Using a within-subjects design, 30 young adults ( M age = 20.0 years) viewed e-cigarette ads in a laboratory. Ad features or areas of interest (AOIs) included: 1) brand logo, 2) product descriptor, and 3) people. During ad viewing, eye-tracking measured participants' dwell time and time to first fixation for each AOI as well as each ad brand. Harm perceptions pre- and post-viewing were measured., Results: Participants spent the longest dwell time on people ( M = 2701 ms), then product descriptors ( M = 924 ms), then brand logos ( M = 672 ms; p s < .001). They also fixated fastest on AOIs in that order. Participant sex significantly impacted dwell time of ad brand, and harm perceptions decreased after viewing the ads ( p s < .05)., Conclusions: This study provides initial evidence about which e-cigarette ad features may appeal most to young adults and may be useful when designing evidence-based policy., Competing Interests: Conflict of Interest Authors have no conflicts of interest.

Introduction: Relative to non-waterpipe (WP) smokers, WP smokers are more than twice as likely to use alcohol and frequently consume alcohol before or during smoking sessions. Co-use of alcohol and WP may result in greater toxicant exposure compared to WP smoking alone. To date, no study systematically has investigated the impact of acute alcohol intoxication on WP smoking topography, exposure to tobacco-related toxicants, or abuse liability., Methods: Dyads of current WP smokers and drinkers (N = 42; age = 21-32 years) completed two in-laboratory ad libitum smoking sessions (≤2 hours) following 12-hour nicotine abstinence in a double-blind, randomized crossover design in which they consumed a placebo versus active drink (sustained breath alcohol concentration = .08). Exhaled carbon monoxide (eCO) and plasma nicotine concentration were assessed. Questionnaires assessed smoking experience and smoking urge. Smoking topography was measured continuously throughout each smoking session., Results: The alcohol session was associated with increased inhaled volume, flow rate, and WP session duration compared to placebo. Compared to placebo, participants reported a more positive overall smoking experience following the alcohol session and greater smoking urges pre- and post-smoking session. Although both sessions resulted in significant increases in eCO and plasma nicotine, no significant differences emerged in eCO or nicotine exposure between the active and placebo sessions., Conclusions: Co-use of alcohol and WP may contribute to the maintenance of WP smoking through enhanced smoking experiences, increased urge to smoke, and significant exposure to addictive nicotine. Regulations may be necessary to limit the sale of alcohol in WP smoking lounges and reduce exposure to secondhand smoke., Implications: The findings suggest co-use of alcohol and WP tobacco likely maintain WP use and dependence by enhancing the smoking experience and increasing urges to smoke. These findings have implications for regulations aimed at limiting co-use of alcohol and WP tobacco in WP lounges and limiting exposure to secondhand smoke., Clinical Trials Registration: NCT03096860., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: JUUL electronic cigarettes have surged in popularity since their emergence on the market in 2015. JUUL is slim and simple in design and is capable of delivering cigarette-like levels of nicotine. However, little research has examined JUUL use patterns, reasons for use, and normative perceptions of JUUL among young adults., Methods: Participants were college students (N = 243) who reported ever using a JUUL electronic cigarette. Eligible participants completed a survey assessing JUUL use patterns, reasons for JUUL use, and normative perceptions of JUUL., Results: Most participants reported using JUUL once or twice (47.7%) and almost one-third reported using JUUL daily or monthly (29.6%). Overall, participants reported a low level of nicotine dependence (M electronic cigarette HONC  = 0.93, SD = 2.04). Cool Mint was the most preferred flavor (35.8%) followed by Mango (12.0%). The top reasons for use were because "friends were using it" (27.0%) and "curiosity" (19.4%). Nearly half (49.8%) of participants reported that they would tell all five of their five closest friends that they use JUUL. Only 10.7% reported a belief that none of their friends would approve of their JUUL use., Conclusions: The high percentage of daily and monthly JUUL users coupled with the relatively high rates of perceived acceptability of use indicates the possibility of high uptake among college students. Findings also suggest college students perceive JUUL as highly acceptable and that their friend's use and curiosity were primary motivators of their initial use, indicating the importance of peer influence in college student JUUL use., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: College student alcohol interventions utilizing public health messaging describe consequences that are delayed and significantly negative, a strategy shown to be ineffective. It is possible that messaging related to immediate, likely, and less negative consequences may be better at reducing problematic drinking. Although research has investigated perceptions of subjective evaluations, no studies have included perceptions of likelihood of occurrence and temporal estimations of alcohol-related consequences. In the current study, we measured perceptions of consequences in terms of likelihood of occurrence, temporal estimations, and subjective evaluations. Methods: Undergraduate students (N = 308) from a large, Midwestern university completed an online survey assessing alcohol use patterns and perceptions of consequences (ie, likelihood of occurrence, temporal estimations, and subjective evaluations). Results: Students perceived failure to graduate and drunk driving to be the least likely, most negative, and most delayed consequences; vomiting and hangovers were the most likely, least negative, and most immediate consequences. Independent t-tests revealed statistically significant differences between high- and low-risk drinkers. Conclusions: Students perceived differences in consequences on temporal estimation, likelihood of occurrence, and subjective evaluations. Future studies should examine how these perceptions affect subsequent alcohol use.

Introduction: JUUL, an e-cigarette from PAX Labs, has captured 70% of the e-cigarette market. The current study examines JUUL use patterns and reasons for initiation in a large convenience sample of U.S. adults., Methods: Respondents were 979 U.S. adults registered on Amazon Mechanical Turk (MTurk) who reported ever using JUUL. Items included frequency/quantity of JUUL use, reasons for trying JUUL, flavor preferences, and use of other tobacco products., Results: The majority of participants reported only trying JUUL once or twice (59.5%), 29.2% reported regular nondaily use and 10.3% reported daily use. The average quantity of JUUL pod use was low in the overall sample (4 pods per month). Daily users reported using ~10 pods per month and engaging in 4-9 separate vaping sessions per day. The most frequently reported reasons for JUUL use were because friends were using it (26.5%), curiosity (20.5%), and similarity to a cigarette (7.7%). Approximately 26% of current JUUL users reported current exclusive JUUL use, while 56% reported using JUUL and another e-cigarette. Of the entire sample, 37.1% were former smokers. Of those, 14.9% were daily JUUL users, 21.4% were nondaily JUUL users, and 63.8% were JUUL triers., Conclusions: This is the first study to examine patterns and reasons for use of the most popular e-cigarette on the market. In this convenience sample, nearly 40% of those who ever tried JUUL reported current daily or daily use. JUUL use may be associated with limited puffing patterns compared to earlier generation e-cigarettes. Research is needed to investigate if JUUL puffing patterns result in decreased exposure to potentially harmful non-nicotine e-liquid constituents compared to other e-cigarettes., (Copyright © 2019. Published by Elsevier Ltd.)

Personal Feedback Interventions (PFIs) have been widely used to reduce the amount of time and money individuals spend on gambling. A central component of these interventions is personalized information about an individual's gambling behavior, often in comparison to others' gambling. The purpose of the present review and meta-analysis was to evaluate these interventions in terms of content, mode of delivery, target sample, and efficacy. Sixteen interventions from 11 studies were reviewed. We found a small, statistically significant effect in favor of PFIs versus control (d = 0.20, 95% CI 0.12, 0.27). Six moderators of intervention efficacy were explored. These interventions appeared to be most efficacious when used in populations of greater gambling severity, when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing. Factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity. Efficacy did not vary as a function of college or community samples. PFIs are a low cost, easily disseminated intervention that can be used as a harm-reduction strategy. However, more substantial effects may be attained if used as part of a larger course of therapy.

Objectives: Waterpipe smoking can lead to negative health outcomes. In this study, we examined responses to anti-waterpipe smoking public service announcements (PSAs). Methods: In a pilot study, current waterpipe smokers (N = 20) and susceptible waterpipe never smokers (N = 25) were randomized to view either 3 anti-waterpipe PSAs, created by the Truth campaign, or 3 control videos. Participants answered questions pertaining to message acceptance at 3 time-points and perceived risk and motivation to quit or avoid waterpipe at 4 time-points. Results: Participants were recruited from the community (N = 45; M age = 22.4 years). Whereas waterpipe smokers and never smokers who viewed the PSAs significantly increased in acceptance of (p < .05) and positive attitudes towards (p < .05) the messages with increased viewing of the mes- sages, waterpipe never smokers did so at a significantly higher rate (p < .05). Waterpipe never smokers who viewed the PSAs had increased perceived severity and susceptibility of health harms of waterpipe compared to the control (p s < .05). We also found gender differences. Conclusions: The 3 tested PSAs from the Truth campaign show evidence of effectiveness against waterpipe use.

Background: Recruitment and retention of participants are important factors in empirical studies. Methods that increase recruitment and retention can reduce costs and burden on researchers related to the need for over-recruitment because of attrition. Rideshare services such as Uber and Lyft are a potential means for decreasing this burden., Objective: This study aimed to understand the role rideshare utilization plays in participant recruitment and retention in research trials., Methods: Data are presented for a study (N=42) in which rideshare services were utilized for participant transportation to and from study visits during a 2-session, in-laboratory research study., Results: Retention at visit 2 was greater than 95% (42/44) in the initial study. In a follow-up survey of the participants from the original trial, participants (N=32) reported that the rideshare service was an important reason they returned for all study visits. Participants reported whether they would prefer differing levels of additional monetary compensation or a ride from a rideshare service. When the additional compensation was less than US $15, participants reported a preference for the rideshare service., Conclusions: Rideshare services may represent a relatively low cost means for increasing study retention. Specifically, findings indicate that rideshare services may not be crucial for initial participant recruitment but for their retention in multi-visit studies., (©Eleanor Ladd Schneider Leavens, Elise Marie Stevens, Emma Irene Brett, Neil Molina, Thad Ryan Leffingwell, Theodore Lee Wagener. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.04.2019.)

Introduction: Polytobacco use and experimentation is common among young adults. Additional research is needed to determine how these patterns of use impact perceptions of tobacco-related harm and risk. The current study examined whether a relationship exists between an increased number of tobacco products used and decreases in perceptions of harmfulness and health risk., Method: Participants (N = 792) completed a survey assessing current/lifetime tobacco use, perceived absolute harmfulness of tobacco/nicotine products and perceived health risk of smoking. For some analyses, participants were grouped by polytobacco use status., Results: Among participants who ever tried a tobacco product, a greater number of products tried was associated with lower perceptions of harm (all p < .05). For e-cigarettes and hookah, nonusers rated tobacco products as more harmful compared to single product, dual, and poly users (all p < .05). Number of products tried predicted perceived harmfulness above and beyond demographic characteristics and polytobacco use status across all products. Similarly, number of products tried predicted perceived health risk above and beyond demographic characteristics and polytobacco use status for both lung cancer and heart disease risk., Discussion: Trying a greater number of tobacco products is associated with lower perceived harmfulness of tobacco products. Prospective studies are needed to determine if experimentation with more tobacco products leads to reductions in perceived risk of tobacco use and subsequent sustained use of tobacco., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Exposure to secondhand smoke (SHSe) can compound an already challenging set of health problems for youth with Sickle Cell Disease (SCD). Exposure to electronic cigarettes may also impact SCD symptomology and respiratory functioning. This study built on these previous findings by a) utilizing two objective measures of SHSe, salivary cotinine and exhaled carbon monoxide and b) examining the association of SHSe with emergency department utilization, physician-reported sickle cell crises, and pulmonary functioning. Caregivers (N = 31 dyads; M age  = 37.6 years; SD = 8.5 years) of youth with SCD (M age  = 9.0 years; SD = 4.5 years) completed self-report measures of tobacco/nicotine use. Youth provided a saliva sample to assess cotinine levels, and performed pulmonary function tests. Dyads provided breath samples for measurement of eCO. A chart review was conducted to obtain medical history and utilization. Majority of youth (88%) were exposed to SHS via salivary cotinine. Interestingly, no significant associations were observed between youth cotinine levels and emergency department utilization, physician-reported sickle cell crises, or pulmonary functioning. Present findings indicate a need to assess for SHSe using objective assessment measures. Future research should investigate which specific factors contribute to increase SHSe/SHVe in youth with SCD.

Background: JUUL, an electronic cigarette, is estimated to occupy 50% of the e-cigarette market and appears to be particularly common among youth. However, there is little research on perceptions of JUUL. The aim of the current study was to examine posts on Reddit specific to JUUL and youth to better understand the context and perceptions of JUUL use., Methods: This content analysis utilized social media discussions posted between January 2015-May 2017. Public posts on Reddit, a social media platform, were gathered and coded. Posters of discussions relevant to both JUUL and youth were included for analysis., Results: 364 posts were included for quantitative content analysis. Posts were mixed in terms of polarity with many (41.1%) including positive and negative language regarding JUUL. In terms of polarity of youth use, 60% of posts showed negative perceptions of youth use. Among posts by youth, only 37% showed negative perceptions of youth use. Posts included a variety of reasons for using JUUL with the most frequent reason being the popularity of JUUL (34.2%) followed by using it to quit smoking (23.3%) and to feel a buzz (20.2%). Age restrictions were the most common barrier to use., Conclusions: Posters generally had a nuanced perception of JUUL and identified both positive and negative aspects. Interestingly, while primary reasons for youth use indicate the strong influence of social norms, barriers to use suggest that public health interventions such as age restrictions may curb youth use. Findings can inform prevention efforts and important factors for JUUL initiation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Alcohol-induced amnesia ("blackout") is a reliable predictor of alcohol-related harm. Given its association with other negative consequences, experience of alcohol-induced amnesia may serve as a teachable moment, after which individuals are more likely to respond to intervention. To test this hypothesis, alcohol-induced amnesia was evaluated as a moderator of brief intervention effect on (a) alcohol-related consequences and (b) the proposed intervention mediators, protective behavioral strategies and peak blood alcohol concentration (BAC). Baseline alcohol risk measured using the Alcohol Use Disorders Identification Test (AUDIT) was also evaluated as a moderator to rule out the possibility that amnesia is simply an indicator of more general alcohol risk. College students (N = 198) reporting alcohol use in a typical week completed assessments at baseline and 1-month follow-up as part of a larger intervention trial. Participants were randomized to assessment only (AO; n = 58) or personalized feedback intervention (PFI; n = 140). Hierarchical regression was used to examine direct and indirect intervention effects. A significant group-by-amnesia interaction revealed that only PFI participants who had experienced alcohol-induced amnesia in the past month reported decreases in alcohol consequences at 1-month follow-up. The PFI reduced alcohol-related consequences indirectly through changes in peak BAC, but only among those who had experienced amnesia at baseline. In contrast, baseline alcohol risk (AUDIT) did not moderate intervention effects, and use of protective behavioral strategies did not statistically mediate intervention effects. Findings suggest that loss of memory for drinking events is a unique determinant of young adult response to brief alcohol intervention. Normative feedback interventions may be particularly effective for individuals who have experienced alcohol-induced amnesia in the past 30 days., (Copyright © 2018. Published by Elsevier Ltd.)

Background: Alcohol consumption and related consequences is a problem on many college campuses. Tailgating parties before college sporting events may be contributing, however, little recent research has investigated alcohol consumption at these events., Objective: The purpose of this study is to evaluate the drinking behaviors of college game day tailgate attendees and subsequent alcohol-related consequences., Methods: Participants (N = 89; 44.9% female) were recruited from tailgates at a university in the Midwest United States on college football game days during fall 2014. Participants provided a breath sample, completed a questionnaire, and were given the opportunity to participate in a follow-up survey (n = 62) to assess resulting alcohol-related consequences., Results: Over half of participants had BrACs greater than 0.000. However, one in three participants reported intentions to abstain from alcohol or to drink but not enough to get buzzed. Intoxication intentions were a significant and unique predictor of alcohol consumption and experience with alcohol-related consequences at follow-up. Conclusions/Importance: This study updates and extends the literature on alcohol-related consequences in the context of college football tailgates. The results suggest that consequences may be prevented through changes in intentions to become intoxicated.

Introduction: Tobacco remains one of the most commonly used substances during pregnancy. Despite the many health risks, pregnant women report low nicotine replacement therapy (NRT) adherence and associated quit rates due partially to perceptions of increased harm related to NRT use. The health risks coupled with the continuation of tobacco use reinforce the need for a greater understanding of these behaviors and attitudes towards NRT and electronic nicotine delivery systems (ENDS) in pregnant women. Therefore, the current study aims to understand pregnant smokers' attitudes towards cessation aids and various tobacco products., Methods: Pregnant women who reported current cigarette smoking (N = 85) were recruited from a Perinatal Center. Participants completed a 19-item self-administered survey relating to tobacco use and NRT interest., Results: Overall, participants reported smoking fewer cigarettes per day since becoming pregnant. Those who had used NRT and/or ENDS prior were willing to use them during their current or future pregnancies. Overall, interest in ENDS use was high (50.6% during pregnancy, 53.5% after pregnancy), despite only 5.9% of participants currently reporting use., Discussion: This study is the first to find that pregnant smokers may be hesitant to use NRT and ENDS instead of combustible tobacco during pregnancy, potentially due to the perceived harmfulness of these products, but feel more willing to use products that they have used previously. Therefore, education and counseling by medical providers regarding varying levels of harm related to use of NRT and nicotine/tobacco products should be included in the routine healthcare of pregnant smokers., Competing Interests: Conflicts of Interest and Disclosures The authors declare no pertinent conflict of interest and did not receive funding for this project.

One-third of college students report past-year heavy episodic drinking, making college student alcohol use an important area for continued research. Research has consistently linked early experiences of adversity to problematic substance use in adolescence and adulthood. Given the negative health consequences associated with heavy episodic drinking, it is imperative to identify mechanisms that contribute to this relation. Low levels of mindfulness have been linked to early adversity as well as impulsivity and alcohol use, therefore, the current study aims to examine the mediating role of mindfulness in the relation between early adversity and current alcohol use and consequences. Undergraduate students (N = 385) at a Midwestern university completed an online questionnaire assessing experiences of childhood adversity, trait mindfulness, and current alcohol use and related consequences. Results indicated that increased adverse experiences and lower levels of mindfulness predicted both increased alcohol consumption and consequences (ps < 0.025), with mindfulness mediating the relationships. Mindfulness is a predictor of alcohol outcomes and appears to mediate the relation between early adversity and alcohol use and consequences. Findings suggest that students with a history of adversity are more likely to exhibit lower levels of mindfulness, which may lead to an increase in alcohol consumption and consequences in early adulthood. Targeted alcohol intervention efforts that incorporate mindfulness skills may be particularly beneficial for those who have experienced early adversity., (Copyright © 2018. Published by Elsevier Ltd.)

Adverse childhood experiences (ACEs) are important public health concerns, with links to higher prevalence rates of both health-risk behaviors and physical health difficulties in adulthood. Research has demonstrated an association between early adversity and long-term health-risk behavior development. The current study assessed the role of emotion dysregulation and facets of impulsivity as potential mediators in the relation between ACEs and general health-risk behaviors, including alcohol-related consequences and risky sexual behavior. College students (N = 668) completed online questionnaires that assessed history of ACEs, emotion regulation difficulties, impulsivity under extreme affect, and current engagement in health-risk behaviors. Emotion dysregulation and impulsivity under extreme positive emotion, but not negative emotion, demonstrated a significant serial mediation between ACEs and alcohol-related consequences. Results also suggest that emotion dysregulation mediates the relation between early adversity and all three outcomes (i.e., overall engagement in maladaptive behavior, alcohol-related consequences, and risky sexual behavior). Impulsivity under positive or negative affect did not demonstrate a mediation effect on the three outcomes. Results of this study highlight the importance of assessing for emotion regulation skills when working with young adults with histories of adversity., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers., Methods: Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up., Results: Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-WP session (p<0.05). Differences were maintained for knowledge of WP-related harms, risk perceptions, and commitment to quitting WP at 3-month follow-up; however, no significant difference (p>0.05) was observed in WP smoking (i.e., days smoked and number of WPs smoked) at 3-month follow-up between the intervention (M=3.97days, SD=9.83; M=6.45 bowls, SD=19.60) and control conditions (M=3.32days, SD=5.24; M=3.49 bowls, SD=5.10)., Conclusions: The current research supports the use of personalized feedback as a useful intervention method to increase commitment to quit WP, but suggests more intensive interventions may be necessary to achieve WP cessation., (Copyright © 2017. Published by Elsevier Ltd.)

Introduction: Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample., Methods: Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS., Results: Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university., Discussion: The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students., (Copyright © 2017 Elsevier Ltd. All rights reserved.)