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Objective: To develop an instrument to examine tobacco-free campus policy components. Participants: Missouri two- and four-year, specialized/technical, and religious colleges and universities (N = 76). Methods: The instrument was informed via literature review and expert interviews. Coder agreement was strong ([kappa] = 0.80). Qualitative policy language examples were identified. Results: Model policy components including consideration for population, prohibited products, location restrictions, enforcement, consequences, promotions, communications, cessation, designated smoking areas and exemptions; comprehensive policies included all populations, for all tobacco products, and at all locations on the campus. Nineteen campuses had comprehensive tobacco-free policies, five had comprehensive smoke-free policies (cigarettes and e-cigarettes), and no policy included all model components. Fifty-two were non-comprehensive. Conclusions: This instrument can allow campuses to identify components for comprehensive and model tobacco-free campus policies and assist officials in improving policy language. Future research can use this instrument to examine the effectiveness of components and their impact on tobacco use outcomes.

BackgroundDespite the popularity of JUUL e-cigarettes, other brands (eg, Elf Bar) may be gaining digital attention. ObjectiveThis study compared Google searches for Elf Bar and JUUL from 2022 to 2023 using Google Health Trends Application Programming Interface data. MethodsUsing an infodemiology approach, we examined weekly trends in Google searches (per 10 million) for “Elf Bar” and “JUUL” at the US national and state levels from January 1, 2022, to December 31, 2023. Joinpoint regression was used to assess statistically significant trends in the search probabilities for “Elf Bar” and “JUUL” during the study period. ResultsElf Bar had less online interest than JUUL at the beginning of 2022. When the US Food and Drug Administration denied JUUL marketing authority on June 23, 2022, JUUL searches peaked at 2609.3 × 107 and fell to 83.9 × 107 on September 3, 2023. Elf Bar searches surpassed JUUL on July 10, 2022, and steadily increased, reaching 523.2 × 107 on December 4, 2022. Overall, Elf Bar’s weekly search probability increased by 1.6% (95% CI 1.5%-1.7%; P=.05) from January 2022 to December 2023, with the greatest increase between May 29 and June 19, 2022 (87.7%, 95% CI 35.9%-123.9%; P=.001). Elf Bar searches increased after JUUL’s suspension in Pennsylvania (1010%), Minnesota (872.5%), Connecticut (803.5%), New York (738.1%), and New Jersey (702.9%). ConclusionsIncreasing trends in Google searches for Elf Bar indicate that there was a growing online interest in this brand in the United States in 2022.

Objectives Adverse birth outcomes among children born to women of color (WOC) have been associated with discrimination during pregnancy; however, little research has explored stressed caused by discrimination as well as pregnancy-specific stress. The purpose of this study was to examine differences in stress and racial discrimination (lifetime and during pregnancy) between U.S. women of different racial/ethnic groups. Methods Women between 18 and 45 years (n = 198; 101 non-Hispanic White, 58 Black, and 39 other WOC [i.e., Hispanic, Asian/Pacific Islander, American Indian, Mixed Race]) completed an online, cross-sectional survey between December 2019 and March 2020. Participants reported pregnancy-specific stress using the pregnancy distress questionnaire (PDQ) and pregnancy life events scale (PLE) and discrimination via the general ethnic discrimination scale (GED). ANOVAs explored differences between racial/ethnic groups' stress and discrimination. Results We found non-Hispanic White (p < 0.05) and other WOC (p < 0.01) reported higher distress during pregnancy than Black women, and other WOC (p < 0.05) reported more stressful prenatal life events (p 0.05) than non-Hispanic Whites. However, Black (p 0.001) and other WOC (p 0.001) both experienced more ethnic discrimination throughout their lifetime and during their pregnancy than non-Hispanic Whites. Also, Black women experienced five times the stress from these encounters than White women (p < 0.001). Conclusions for Practice Previously developed pregnancy distress questionnaires may be better suited for non-Hispanic White populations and may miss important experiences unique to marginalized populations such as racial/ethnic discrimination. Adaptations to pregnancy-related stress scales are warranted given the toxicity of discrimination during pregnancy., Author(s): Aleyah Johnson [sup.1] , Page D. Dobbs [sup.1] [sup.2] [sup.3] , Lois Coleman [sup.1] [sup.4] , Sarah Maness [sup.1] [sup.5] Author Affiliations: (1) grid.266900.b, 0000 0004 0447 0018, Department [...]

Objective: To examine the relationship between demographics, other tobacco use, and JUUL dependency on combustible cigarette use among college JUUL users. Participants: Undergraduates (n = 595) at a large southwestern university who used JUUL weekly completed a cross-sectional online survey in March 2019. Methods: Logistic regressions examined associations between covariates and ever use/past 30-day use of cigarettes. Results: As age increased, odds of ever trying a cigarette increased (AOR = 1.87; 95% CI = 1.45-2.41); however, as age of JUUL initiation increased, odds of ever (AOR = 0.80; 95% CI = 0.65-0.99) or past 30-day (AOR = 0.78; 95% CI = 0.63-0.97) cigarette use decreased. Those moderately (AOR = 2.03; 95% CI = 1.07-3.82) or highly (AOR = 8.01; 95% CI = 3.08-20.83) dependent on JUUL were more likely to have tried cigarettes than those not dependent. However, dependence was not associated with past 30-day use. Conclusions: JUUL users may not transition to combustible cigarettes during college. Longitudinal studies are needed to examine transitions in JUUL users' tobacco product use after college.

Objective: The purpose of this study was to compare knowledge about human papillomavirus (HPV) and HPV vaccine, college student's beliefs toward HPV, and HPV vaccine uptake between US and international college students studying in the US. Participants: The study was conducted using a sample (N = 588) of college students from a university in the South Central US. Methods: Study measures was derived from previously validated measures. Data were collected via an online survey using Qualtrics. Results: Significant differences were found in HPV awareness, HPV vaccine awareness, and HPV vaccine uptake between US and international college students. Conclusion: This study showed existing disparities between US and international college students regarding HPV and HPV vaccine awareness, and HPV vaccine uptake. College health centers can play a crucial role in raising awareness of HPV and HPV vaccination rates by organizing various intervention programs to reduce these disparities.

BackgroundOn December 20, 2019, the US “Tobacco 21” law raised the minimum legal sales age of tobacco products to 21 years. Initial research suggests that misinformation about Tobacco 21 circulated via news sources on Twitter and that sentiment about the law was associated with particular types of tobacco products and included discussions about other age-related behaviors. However, underlying themes about this sentiment as well as temporal trends leading up to enactment of the law have not been explored. ObjectiveThis study sought to examine (1) sentiment (pro-, anti-, and neutral policy) about Tobacco 21 on Twitter and (2) volume patterns (number of tweets) of Twitter discussions leading up to the enactment of the federal law. MethodsWe collected tweets related to Tobacco 21 posted between September 4, 2019, and December 31, 2019. A 2% subsample of tweets (4628/231,447) was annotated by 2 experienced, trained coders for policy-related information and sentiment. To do this, a codebook was developed using an inductive procedure that outlined the operational definitions and examples for the human coders to annotate sentiment (pro-, anti-, and neutral policy). Following the annotation of the data, the researchers used a thematic analysis to determine emergent themes per sentiment category. The data were then annotated again to capture frequencies of emergent themes. Concurrently, we examined trends in the volume of Tobacco 21–related tweets (weekly rhythms and total number of tweets over the time data were collected) and analyzed the qualitative discussions occurring at those peak times. ResultsThe most prevalent category of tweets related to Tobacco 21 was neutral policy (514/1113, 46.2%), followed by antipolicy (432/1113, 38.8%); 167 of 1113 (15%) were propolicy or supportive of the law. Key themes identified among neutral tweets were news reports and discussion of political figures, parties, or government involvement in general. Most discussions were generated from news sources and surfaced in the final days before enactment. Tweets opposing Tobacco 21 mentioned that the law was unfair to young audiences who were addicted to nicotine and were skeptical of the law’s efficacy and importance. Methods used to evade the law were found to be represented in both neutral and antipolicy tweets. Propolicy tweets focused on the protection of youth and described the law as a sensible regulatory approach rather than a complete ban of all products or flavored products. Four spikes in daily volume were noted, 2 of which corresponded with political speeches and 2 with the preparation and passage of the legislation. ConclusionsUnderstanding themes of public sentiment—as well as when Twitter activity is most active—will help public health professionals to optimize health promotion activities to increase community readiness and respond to enforcement needs including education for retailers and the general public.

Objectives: In an attempt to reduce tobacco use among adolescents in the USA, some health educators have created school-based tobacco education programmes. However, none currently exist for middle and high school educators. The current study sought to determine if middle and high school educators' knowledge about combustible cigarettes and electronic cigarettes (e-cigarettes) improved following an educational session about youth tobacco use. Design: Pre-/post-assessment was employed to measure change in knowledge. Setting: Educators (N = 41) from a rural, southern middle and high school were invited to take part in the study during an educational workshop held during an in-service training event. Method: In addition to seven knowledge questions, participants also provided demographic information and details of current and previous use of cigarettes and e-cigarettes. Chi-square analyses examined changes in responses to individual items, and total pre-/post-knowledge score change was compared using a dependent t-test. Independent t-tests examined differences between knowledge change and participants' personal and behavioural characteristics. Results: Participants' overall knowledge improved from pre- to the post-test (p < 0.05); however, there was no relationship between pre-/post-test responses for individual items. In addition, there were no differences between participants' knowledge change when compared by age, sex, grades taught and past use of cigarettes or e-cigarettes. Discussion: Increasing middle school and high school educators' knowledge about tobacco products, particularly novel devices, is important due to the increasing rates of use among youth. More research is needed to determine how educators' knowledge can help decrease tobacco initiation and use among school-aged children.

Objective: To develop an instrument to examine tobacco-free campus policy components. Participants: Missouri two- and four-year, specialized/technical, and religious colleges and universities (N = 76). Methods: The instrument was informed via literature review and expert interviews. Coder agreement was strong (κ =.80). Qualitative policy language examples were identified. Results: Model policy components including consideration for population, prohibited products, location restrictions, enforcement, consequences, promotions, communications, cessation, designated smoking areas and exemptions; comprehensive policies included all populations, for all tobacco products, and at all locations on the campus. Nineteen campuses had comprehensive tobacco-free policies, five had comprehensive smoke-free policies (cigarettes and e-cigarettes), and no policy included all model components. Fifty-two were non-comprehensive. Conclusions: This instrument can allow campuses to identify components for comprehensive and model tobacco-free campus policies and assist officials in improving policy language. Future research can use this instrument to examine the effectiveness of components and their impact on tobacco use outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION Quality of patient–provider communication regarding tobacco use may encourage cessation that could lead to improved health outcomes for mothers and children. However, currently there are no validated measures of frequency and quality of patient–provider communication about cigarettes and e-cigarettes. The objective of this study was to adapt and validate measures of frequency and quality of patient–provider communication about smoking and e-cigarette use among a sample of pregnant mothers who currently smoked. METHODS An online sample of US pregnant women who reported past 30-day smoking were recruited to complete a cross-sectional, online survey (n=267). An exploratory factor analysis examined the factor structure of four measures of frequency and quality of patient–provider communication about cigarettes and e-cigarettes among those who reported prior communication with their provider about cigarettes and e-cigarettes (n=170). Relationships between measures were explored, and a logistic regression explored each measure’s association with intention to switch from cigarettes to e-cigarettes. RESULTS Items measuring the frequency of communication loaded onto one factor for both cigarettes and e-cigarettes (α=0.88). Quality of communication loaded onto two factors for both cigarettes and e-cigarettes, termed active communication and internalized perception. Internalized perceptions of communication quality about cigarettes (β= -0.32, p<0.002), active communication (β=0.46, p<0.02), and internalized perceptions of communication about e-cigarettes (β= -0.36, p<0.001) were related to intention to switch, in separated models. CONCLUSIONS Quality conversations between healthcare providers and pregnant patients is likely more important for behavioral decision-making than the frequency of communication. [ABSTRACT FROM AUTHOR]

Objective: This convergent mixed methods study examined how information sources influence college students' beliefs and knowledge about vaping. Participants: College students either completed a survey (n = 522; January-April, 2016) or were interviewed (n = 33; 2015-2016). Methods: College students completed an online survey asking 'where' students had heard about e-cigarette and 'what' they had heard. Responses were quantified and a chi-square analysis was conducted. Additional college student e-cigarette users were interviewed about the credibility of information sources. Thematic analysis was conducted with the coded interviews. Results: There was a significant relationship between information sources for e-cigarettes (social sources, media, advertising, education/research) and the messages they recalled. Friends who vaped and e-cigarette users were the most credible information sources. Confirmation bias and scientific impotence bias characterized assessment of e-cigarette information. Conclusions: Health education specialists working on college campuses should provide accurate information via communication channels most unitized by college students.

Background: Some electronic cigarette (e-cigarette) users report using these products to quit smoking combustible cigarettes. Purpose: Using the Reasoned Action Approach (RAA), we sought to develop, confirm, and explore a measure of current smokers' intentions, attitudes (instrumental and experiential), social norms (injunctive and descriptive), and perceived behavioral control (capacity and autonomy) to use e-cigarettes to quit smoking. Methods: A sample of US young adults completed one of two cross-sectional online surveys. For the first sample (n = 315) exploratory factor analysis (EFA) was used to examine the structure of the original 31-item instrument. The second sample (n = 315) confirmed the model using confirmatory factor analysis (CFA). Structural equation modeling (SEM) tested the constructs' ability to predict intention. Results: SEM indicated instrumental attitudes (p < 0.05), experiential attitudes (p < 0.01), and injunctive norms (p < 0.05) predicted young adults' intentions to use e-cigarettes to quit smoking (r[superscript 2] = 0.43). Discussion: Further exploration is needed to determine if intention to use e-cigarettes to quit smoking is predictive of short- and long-term smoking abstinence. Translation to Health Education Practice: Health educators should emphasize the experience of using e-cigarettes, the importance of quitting cigarettes completely, and injunctive norms who support young adults switching to these devices.

Objective: This study examined if college students used particular e-cigarette devices for different reasons. Participants: College students from a large southern university completed an online, close- and open-ended survey. Data were delimited to those 18-25 years of age who had used e-cigarettes (n = 338). Methods: A convergent mixed-methods design was employed by quantifying qualitative responses via an inducting coding method. Next, X[superscript 2] analyses examined relationships between use of different products (i.e., cigalikes, vape pens, eGos, mods) and reasons for using e-cigarettes. Results: Emerging themes representing reasons for trying e-cigarettes included: curiosity, peer pressure, recreation, flavors, better than cigarettes, and to quit/reduce tobacco use. Significant relationships existed between use of cigalikes, (p < 0.01), eGos (p < 0.05), and mods (p < 0.05) and use of e-cigarettes to quitting/reducing tobacco use. Conclusions: Health promotion efforts on college campuses should address curiosity about these products and provide scientifically proven therapy to those seeking to quit tobacco.

Objectives The purpose of this study was to examine differences between perceived harm of cigarette and electronic cigarette (e-cigarette) use while pregnant and differences between healthcare providers' communication about these products during pregnancy. Methods A convenience sample of gestational women (n = 218; ages 18-45) living in the US completed an online survey between May and December 2017. Participants reported perceived likelihood of adverse health outcomes (e.g., low birth weight, sudden infant death syndrome) among infants/children born to mothers who used cigarettes/e-cigarettes. T-tests and two-way ANOVAs examined differences between risk perceptions of using cigarettes/e-cigarettes while pregnant based on pregnancy status (previously pregnant, currently pregnant, future pregnant). Chi-square analyses examined differences between healthcare provider communication about cigarette/e-cigarette use during pregnancy. Results Overall, participants believed adverse health outcomes were significantly more likely to be caused by maternal use of cigarettes than e-cigarettes. Participants who planned to be pregnant reported higher endorsement that smoking combustible cigarettes would cause a miscarriage (p < .05) or increased blood pressure (p < .05) for a child than currently pregnant participants. Participants reported healthcare providers asked about (p < .05), advised them not to use (p < .001), and talked to them about health effects of smoking combustible cigarettes while pregnant (p < .001) significantly more than e-cigarettes. Conclusions for Practice Healthcare providers working with pregnant women should perform the 5As behavioral intervention method to provide pregnant women with tobacco cessation care. They should also discuss the absolute harm nicotine exposure (via cigarettes or e-cigarettes) can have on fetal health and development., Author(s): Page D. Dobbs [sup.1] [sup.5] , Yu Lu [sup.2] , Sarah Maness [sup.2] , Lois Coleman [sup.2] , Aleyah Johnson [sup.2] , Samantha Metz [sup.3] , Charlie Vidal [sup.4] [...]

Social determinant research has noted educational attainment to be among the strongest influencing factors for tobacco use during pregnancy. Concurrently, maternal e-cigarette use has doubled in recent years, with some citing it as a safer alternative to combustible cigarettes. To better understand the decision-making practices of pregnant persons based on educational attainment, the reasoned action approach (RAA) was used to evaluate factors that may be associated with the intention to switch from cigarettes to e-cigarettes. A sample of U.S. pregnant persons (n = 267) between 18-40 years of age, who smoked at least one cigarette in the past 30 days, completed an online survey about switching from cigarettes to e-cigarettes. RAA constructs (e.g., intentions, instrumental attitudes, etc.) were measured using a pre-validated scale. Using structural equation modeling, the variability of latent variables (i.e., RAA constructs) and their interaction with one another were analyzed by educational attainment via two regression models: one for those who had college experience or had completed a college degree and another for those who had not attended college. Instrumental attitudes, experiential attitudes, and descriptive norms were significantly associated with intention to switch from cigarettes to e-cigarettes among both groups; however, autonomy was only significantly associated with intention among those who had not attended college. The RAA offers a valuable framework for understanding pregnant persons’ decision to switch from cigarettes to e-cigarettes during pregnancy; however, the RAA constructs may be related to intentions differently based on upstream factors, such as educational attainment.

BackgroundElectronic nicotine delivery systems (known as electronic cigarettes or e-cigarettes) increase risk for adverse health outcomes among naïve tobacco users, particularly youth and young adults. This vulnerable population is also at risk for exposed brand marketing and advertisement of e-cigarettes on social media. Understanding predictors of how e-cigarette manufacturers conduct social media advertising and marketing could benefit public health approaches to addressing e-cigarette use. ObjectiveThis study documents factors that predict changes in daily frequency of commercial tweets about e-cigarettes using time series modeling techniques. MethodsWe analyzed data on the daily frequency of commercial tweets about e-cigarettes collected between January 1, 2017, and December 31, 2020. We fit the data to an autoregressive integrated moving average (ARIMA) model and unobserved components model (UCM). Four measures assessed model prediction accuracy. Predictors in the UCM include days with events related to the US Food and Drug Administration (FDA), non-FDA-related events with significant importance such as academic or news announcements, weekday versus weekend, and the period when JUUL maintained an active Twitter account (ie, actively tweeting from their corporate Twitter account) versus when JUUL stopped tweeting. ResultsWhen the 2 statistical models were fit to the data, the results indicate that the UCM was the best modeling technique for our data. All 4 predictors included in the UCM were significant predictors of the daily frequency of commercial tweets about e-cigarettes. On average, brand advertisement and marketing of e-cigarettes on Twitter was higher by more than 150 advertisements on days with FDA-related events compared to days without FDA events. Similarly, more than 40 commercial tweets about e-cigarettes were, on average, recorded on days with important non-FDA events compared to days without such events. We also found that there were more commercial tweets about e-cigarettes on weekdays than on weekends and more commercial tweets when JUUL maintained an active Twitter account. Conclusionse-Cigarette companies promote their products on Twitter. Commercial tweets were significantly more likely to be posted on days with important FDA announcements, which may alter the narrative about information shared by the FDA. There remains a need for regulation of digital marketing of e-cigarette products in the United States.

Despite Latino Americans having been found to be disproportionally affected by COVID-19, they report higher hesitancy to receive the COVID-19 vaccine than non-Hispanic whites. The purpose of this study was to examine factors that influence Puerto Rican's intentions to get the COVID-19 Vaccine. A sample (n = 173) of people who currently lived in Puerto Rico were recruited to complete an online, cross-sectional survey about their intention to receive the COVID-19 vaccine. Demographics and vaccine hesitancy were assessed, and logistic regressions explored relationships between variables and intention to get the COVID-19 vaccine when it became available. When controlling for covariates, 30–49-year-olds (aOR = 0.12) and those who had refused a vaccine in the past (aOR = 0.07) had lower odds of vaccine uptake than those between 18 and 29 years and who had not previously refused a vaccine, respectively. Those who had completed at least a 4-year college degree (aOR = 6.78) had greater odds of intending to get vaccinated than their counterparts. Health education campaigns about COVID-19 in Puerto Rico should be tailored to working-age adults who may mistrust information they have heard about the vaccine. Messages could be tailored to preferred communication channels to decrease vaccination hesitancy.

Cigarette smoking is the leading cause of preventable deaths worldwide. Research has documented an association between psychological distress and smoking among certain racial/ethnic groups but has not examined this association among Native Hawaiian and Pacific Islander (NHPI) adults. Data from the 2014 general and the NHPI-specific National Health Interview Surveys were analyzed at the University of Arkansas for Medical Sciences Regional Campus (Fayetteville, AR) in April 2021 to determine the association between current cigarette smoking and levels of psychological distress among NHPI adults and to assess the difference in the magnitude of that association among NHPI adults compared to adults of other racial/ethnic groups in the United States. The final analytic sample (n = 34,782) included 1,916 NHPI, 20,430 White, 4,725 Black, 2,001 Asian, and 5,710 Hispanic adults. A significant association between current cigarette smoking and psychological distress levels was found among NHPI adults as well as among adults from other racial/ethnic groups. There was no significant difference in the magnitude of the detected association among NHPI adults compared to the magnitude of the same association detected among adults of other racial/ethnic groups. However, this finding indicates race/ethnicity does not moderate the association between psychological distress and current cigarette smoking. Future studies should explore factors that may further explain the variation in current cigarette smoking within and across all racial/ethnic groups.