Adapting E-cigarette prevention programming to reach the latinx community.

PURPOSE: E-cigarettes are the most commonly used tobacco product among youth in the United States. Yet evidence-based prevention programming is limited due to the rapid onset of this threat. Community-based efforts to address vaping largely target youth in school settings. Although parents can play an important role in youth tobacco control efforts, messages about the dangers of vaping, use among adolescents, and strategies for intervening have not reached many Spanish-speaking parents in low-income Latinx communities. Our community-academic team developed e-cigarette prevention programming for use by promotor/as de salud to address this unmet need. METHODS: During the 1-year project, the team worked closely with a Project Advisory Committee to: review existing evidence-informed materials; conduct focus groups with parents, youth and promotor/as to guide program development; develop a curriculum to prepare promotor/as to educate low-literacy, Spanish-speaking parents about vaping; craft Spanish language resources for promotor/as to use in community education sessions; train 61 promotor/as to deliver the program; and support program delivery to 657 community members. RESULTS: Focus groups with promotor/as and community members, key-informant interviews, and brief surveys informed program development and assessment. Community member feedback was essential to development of appropriate materials. Promotor/as demonstrated significant pre- to post- training increases in e-cigarette knowledge and confidence in delivering vaping prevention education. Community members demonstrated a mastery of basic e-cigarette concepts and expressed intention to discuss vaping with their children. CONCLUSIONS: Promotor/a-led programming for parents represents a promising approach to vaping prevention and control in the Latinx community.

Content analysis of email marketing communications among online e-cigarette retailers.

INTRODUCTION: Online e-cigarette retailers use email communications to promote products directly to consumers, which may facilitate e-cigarette use. Little is known about the content of these emails. As such, this study collected emails from online e-cigarette retailers in California to conduct a content analysis. METHODS: This study included 13 online e-cigarette retailers in California using Yelp. To be included in the study, e-cigarette retailers needed a live website, physical retail location (i.e., vape shop), and e-cigarettes available for purchase online. The research team entered each website and signed up (if possible) for an email newsletter. Data were collected from the Gmail Application Programming Interface over a 1-year study period (11/01/21-11/01/22). Members of the research team coded emails for the presence of e-cigarettes, other products, flavors, marketing categories, and promotional activities, among other variables. RESULTS: 749 promotional emails (2.1 avg/per day) were received over the 1-year study period. Second-generation e-cigarettes (n=581, 77.6%) were the most observed product in emails followed by disposable e-cigarettes (n=391, 52.2%). The most common flavor profile was fruit/sweet/liquor (n=424, 56.6%). Emails included links to social media pages (n=366, 48.9%). Online coupons were found in 53.1% (n=398) of the emails. Age warnings were displayed in 8.0% (n=60) of the emails. CONCLUSIONS: E-cigarette retailers' emails promoted new products, flavors, and contained promotional discounts. Future research should examine the impact of exposure to such emails on e-cigarette-related attitudes and behaviors. IMPLICATIONS: Findings from this study may help inform prevention programs and interventions focused on increasing tobacco-related digital media literacy (i.e., evaluate tobacco advertising messages on digital media) among gender and ethnic minorities. Future research should examine if exposure to email marketing is causally linked with e-cigarette use among gender and ethnic minorities.

Co-design of digital public health substance use resources: A collaboration between young people and experts.

ISSUE ADDRESSED: Substance use and mental illness remain critical issues for young Australians, however, engagement with evidence-based health resources is challenging among this age group. This study aimed to develop engaging, useful digital health resources, underpinned by neuroscience principles, to build awareness of the harms of electronic cigarettes (e-cigarettes) and concurrent alcohol and antidepressant use. METHODS: A mixed-methods approach was adopted to co-design two evidence-based videos resources. The resources were co-designed with the Matilda Centre's Youth Advisory Board Centre's Youth Advisory Board through a series focus groups and individual feedback reviews. Young people residing in New South Wales were then invited to complete a survey to evaluate the usefulness, relatability and impact on perceived harms associated with each substance pre- and post-viewing resources. RESULTS: A total of 100 participants completed the survey (mean age = 21.5 years, SD = 2.77, 42% Female, 2% Non-binary). The animated videos were well received, with the large majority (91% and 87% respectively) of participants rating them 'excellent' or 'very good'. After viewing the videos, there was a significant increase in the perception of harm associated with e-cigarette use, monthly (t(99) = 2.76, p = .003), weekly (t(99) = 4.82, p < .001) and daily (t(99) = 4.92, p < .001), and consuming alcohol whilst taking antidepressants both weekly (t(100) = 2.93, p = .004) and daily (t(100) = 3.13, p = .002). CONCLUSIONS: This study describes a successful co-design process demonstrating how meaningful involvement of young people, alongside traditional research methods, can produce substance use prevention resources that are useful, engaging and increase knowledge of harms among young people. SO WHAT?: To achieve meaningful public health impact researchers, experts and digital creators can work together to co-create substance use educational materials that are engaging, well-liked, while imparting important health knowledge.

[Tabacco harm reduction: the need for a paradigm shift in German tobacco control policy]. / Tabak Harm Reduction: Die Notwendigkeit eines Paradigmenwechsels in der deutschen Tabakkontrollpolitik.

The consumption of tobacco continues to be the greatest preventable health risk in Germany. Every year, more than 127,000 people die prematurely as a result of using tobacco - one in five new cases of cancer is a consequence of smoking. Germany's current tobacco control policy, consisting of advertising bans, the promotion of smoke-free environments, and an abstinence-only paradigm, are only able to initiate slow change. Other countries have shown how the number of smokers can be reduced and deaths prevented by integrating harm reduction as a complementary measure and providing a much more active support for people who want to quit. This article first presents the current situation and current measures in Germany. Then recommendations for changes to the current tobacco control policy in Germany are derived from a look at the United Kingdom, which is considered a pioneer throughout Europe with its tobacco control policy, as well as a summary of the current state of research.

Re: "Impact of the e-cigarette era on cigarette smoking among youth in the United States: A population-level study".

This is a letter to the editor of Preventive Medicine responding to Harrell et al.'s "Impact of the e-cigarette era on cigarette smoking among youth in the United States: A population-level study." (Harrell MB, Mantey DS, Baojiang C, Kelder SH, Barrington-Trimis J. Impact of the e-cigarette era on cigarette smoking among youth in the United States: A population-level study. Preventive Medicine 2022;164:107265).

Re: Impact of the "e-cigarette era" on cigarette smoking among youth: A population-level study.

Our original paper is: Harrell MB, Mantey DS, Baojiang C, Kelder SH, Barrington-Trimis J. Impact of the e-cigarette era on cigarette smoking among youth in the United States A population-level study. Preventive Medicine 2022; 164:107265). This is a response to correspondence received from Foxon and Juul Labs Inc. (JUUL) regarding our original paper.

Commentary on "Increased nicotine vaping due to the COVID-19 pandemic among US young adults: Associations with nicotine dependence, vaping frequency, and reasons for use".

This manuscript is a correspondence referencing an article published in Preventive Medicine.

Perceptions of a prescription model for accessing nicotine vaping products: an examination of submissions made by self-reported e-cigarette users to an Australian consultation.

In response to rapid and substantial increases in rates of e-cigarette use among young people, Australia's Therapeutic Goods Administration (TGA) made changes to the regulations governing nicotine vaping products. As part of the regulatory change process, Australians were invited to comment on the proposed regulations, which featured the introduction of a prescription model for nicotine vaping products. To inform strategies to enhance compliance with the tightened regulations, this study examined submissions made by self-reported e-cigarette users to the TGA's public consultation (n = 1405). A content analysis was conducted to identify and quantify key arguments. Claims about possible negative consequences associated with the regulations (e.g. people will return to smoking, inconvenience) featured in most submissions (84%). Around half (55%) of submissions mentioned perceived benefits of e-cigarettes, including favourable health outcomes (e.g. improved breathing) and enhanced tobacco cessation. Around half (52%) featured concerns about inconsistency in treatment and the argument that e-cigarettes should not be restricted when more harmful tobacco products are readily available. Alternative approaches to a prescription model were offered in nearly one-third (31%) of submissions. One-quarter (26%) included text provided by an industry-led astroturfing campaign. The arguments made in the analysed submissions suggest a lack of appreciation of (i) the negative health outcomes associated with e-cigarette use and (ii) evidence linking these devices to smoking relapse. Results highlight the need for targeted health campaigns that address (i) gaps in consumers' knowledge and (ii) vaping-related misinformation being promulgated by the industry and its allies.

"Better Than Any DARE Program": Qualitative Analysis of Adolescent Reactions to EVALI Television Storylines.

Introduction. Research suggests that awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) among adolescents is associated with increased harm perception of e-cigarettes. The depiction of EVALI on three primetime medical dramas offers an opportunity to examine the use of these storylines for tobacco prevention education. Methods. We conducted four focus groups with seventh- and eighth-grade students at an urban middle school. Participants viewed three clips of scenes followed by a facilitated discussion as to the influence of the clips on knowledge and perceptions of e-cigarettes and the use of clips for tobacco prevention education. Two research assistants double-coded notes from the focus groups using a qualitative content analysis approach. Results. Our final sample included 78 adolescents; we obtained self-reported demographic information for 75. The majority of participants were 13 to 14 years of age (82.7%) and identified as cisgender female (52.0%) and Black (52.0%). No participants had knowledge of EVALI prior to viewing the clips. Comments made both during and after watching suggest the clips may have reinforced knowledge and perceptions of harm; participants stated that the clips could be a useful intervention tool. Viewing the clips also generated unprompted discussion about flavored products, tobacco advertising, other television programs, and marijuana. Conclusions. Clips featuring the depiction of EVALI on medical dramas may be an effective tool for raising awareness of e-cigarette use-related harms. These results offer a promising first step for future collaborative research between public health, adolescents, and schools to develop tobacco prevention education utilizing these clips.

School Factors Associated With Past 30-Day E-Cigarette Use Among Hispanic Youth.

E-cigarettes are a popular type of nicotine product among youth in the United States. Hispanic youth, one of the fastest growing populations in the United States, are second only to white youth for e-cigarette use. Analysis of the Parents' Resource Institute for Drug Education data was conducted to determine past 30-day e-cigarette use among Hispanic youth (n = 4,602) and also examined school factors related to such use. Findings indicated that 13.8% of Hispanic youth used e-cigarettes in the past 30 days. Multivariate logistic regression analysis determined several school factors (e.g., poor grades, grade level) related to e-cigarette use. School-based prevention programs are needed to reduce and eliminate e-cigarette use among Hispanic youth.

Decreases in smoking and vaping during COVID-19 stay-at-home orders among a cohort of young adults in the United States.

In Spring 2020, most US states and territories implemented stay-at-home orders to slow transmission of the novel coronavirus SARS-CoV2, the cause of COVID-19. Little is known about the impact of stay-at-home orders on tobacco and nicotine use including among young adults. The current study examined participants (N = 1727) completing three recent survey waves from a longitudinal cohort of young adults recruited in 2010 from North Carolina and Virginia, USA: Wave 13 (Spring 2019), Wave 14 (Fall 2019), and Wave 15 (Spring 2020) to assess changes in cigarette and e-cigarette use. We conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 14 relative to Wave 13 to establish if there was a trend of use pre-pandemic. Then, we conducted logistic regression analyses to compare the odds that participants reported smoking or vaping in Wave 15 relative to Wave 14 to determine the impact of COVID-19 stay-at-home orders. When comparing the odds of reporting tobacco use at Wave 14 to Wave 13, no differences emerged (p > 0.05). However, when comparing tobacco use at Wave 15 to Wave 14, participants had 40% lower odds of reporting past 30-day cigarette use (p = 0.02) and 50% lower odds of reporting past 30-day e-cigarette use (p < 0.01). The current study provides initial evidence that young adults may have reduced their tobacco and nicotine use during the stay-at-home orders. However, more work is needed to determine the long-term impact of the COVID-19 pandemic on tobacco use and cessation in this population.

Effect of flavored E-cigarette bans in the United States: What does the evidence show?

The United States federal government, along with many state and local governments, have passed restrictions on electronic cigarette ("e-cigarette") sales with the stated purpose of preventing youth use of these products. The justification for these restrictions includes the argument that youth e-cigarette use will re-normalize youth smoking, leading to increased rates of cigarette smoking by teenagers. However, in this paper, we propose an evidence-based version of this model based on several years' worth of longitudinal and econometric research, which suggests that youth e-cigarette use has instead worked to replace a culture of youth smoking. From this analysis, we propose a re-evaluation of current policies surrounding e-cigarette sales so that declines in e-cigarette use will not come at the cost of increasing cigarette use among youth and adults.

Longitudinal associations between U.S. youth exposure to E-cigarette marketing and E-cigarette use harm perception and behavior change.

E-cigarette marketing tactics to reach and appeal to youth are rapidly changing. This study examined to what extent youth e-cigarette marketing exposure was associated with e-cigarette use behavior change one year later, during a time when youth e-cigarette use was starting to surge in the U.S. Using nationally representative longitudinal public-use data from the Population Assessment of Tobacco and Health (PATH) Study, we examined associations between recalled e-cigarette marketing exposure (2016-2018) at Wave (W) 4 and e-cigarette use harm perception and behavior change (ever, current, and regular use) one year later (W4.5; 2017-2018) among W4 never tobacco users (n = 9405). Recall of exposure to e-cigarette marketing through different channels was also examined in multivariable models controlling for socio-demographic factors and established e-cigarette use risk factors. Results show that the most frequently recalled channels of e-cigarette marketing exposure were retail stores (50.3%), television (22.2%), and websites/social media (20.2%). Over one year, 21.2%, 7.8%, 3.4%, and 1.2% of respondents reported reduced harm perceptions, and ever, current, and regular use of e-cigarettes, respectively, at follow-up. Recalled exposure to e-cigarette marketing was associated with reduced e-cigarette harm perception (AOR = 1.20; 95% CI = 1.05-1.37) and ever (AOR = 1.26; 95% CI = 1.01-1.56) and current use (AOR = 1.40; 95% CI = 1.02-1.92) at follow-up. E-cigarette marketing exposure through websites/social media was associated with reduced harm perceptions and all stages of e-cigarette use change, including regular use. Identifying marketing techniques and channels that change youth e-cigarette harm perceptions and influence e-cigarette use progression is essential to inform e-cigarette regulatory policies and prevention campaigns.

Evaluation of a pharmacy supported e-cigarette smoking cessation intervention in Northwest England.

BACKGROUND: Cigarette smoking cessation has been described as the world's most important public health intervention. Electronic cigarettes are a relatively new tool for assisting smoking cessation but there is a lack of data on their efficacy. This article reports on a pharmacy supported e-cigarette smoking cessation intervention undertaken in a metropolitan area in the north of England. METHODS: Longitudinal mixed-methods evaluation incorporating analysis of secondary data, interviews with service users, and interviews with service providers at 3-month and 12-month follow-up, with an additional text message survey of service users at 12-month follow-up. RESULTS: The four-week follow-up data suggest that for every twenty people given an e-cigarette, six quit smoking tobacco and three people cut their cigarette intake by more than five cigarettes per day. Long-term follow-up results were positive but only a small number of participants were still engaged with the study at 12 months. Service users and providers spoke positively about the combination of e-cigarettes and pharmacy support. CONCLUSIONS: E-cigarette distribution combined with pharmacy support appears to be an agreeable and effective intervention for smoking cessation, but further data are needed on long-term quit rates and health effects.

E-cigarette Use Among Young Adult Patients: The Opportunity to Intervene on Risky Lifestyle Behaviors to Reduce Cancer Risk.

Use of e-cigarettes and other electronic nicotine delivery systems (ENDS) is on the rise. We administered a health needs survey via email to 804 adult primary care and oncology patients at a large urban academic medical center in 2019. We examined differences in e-cigarette use by smoking status, personal history of cancer, alcohol use, and second-hand tobacco smoke exposure. Of the 804 participants, 90 (11.2%) reported ever using e-cigarettes. E-cigarette use was more prevalent in young adults (risk ratio [RR] for 18-24 years: 4.58, 95% confidence interval [95% CI] 2.05, 10.26), current smoking (RR 4.64, 95% CI 1.94, 11.07), very often/often binge drinking (RR 3.04, 96% CI 1.38, 6.73), and ≥ 1 smokers in the home (RR 3.90, 95% CI 2.10, 7.23). Binge alcohol consumption and tobacco smoking are associated with increased risk cancer. Inquiries about e-cigarette use among adults 25-40 years present providers the opportunity to also counsel young adult about reducing cancer risk.

Correlates of vaping among adolescents in Canada.

Background: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk. Data and methods: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours. Results: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping. Interpretation: An adolescent's risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

Implementation of a youth and young adult e-cigarette cessation program within a dental clinic setting : A SToHN feasibility study.

Introduction: While significant progress has been made to decrease tobacco smoking among youth and young adults, e-cigarettes threaten to reverse the progress. The purpose of this study was to test the feasibility of the ReACH Assessment of Knowledge for E-Cigarettes (RAKE) e-cigarette cessation program targeting youth and young adults in Texas. Methods: Seven dental practitioners and 12 patients participated in this pilot study. Patients aged 15 to 29 who reported current e-cigarette use were recruited by their dental practitioner. All participants completed pre-and post-assessments-practitioners receiving the RAKE training and patients the RAKE cessation intervention. Descriptive statistics were calculated. Results: After RAKE training, all practitioners reported the RAKE cessation program as useful and an important part of patient care. In addition, after completing the program (5A's), 67% (n=9) patients reported that the program was helpful, and 100% (n=12) would recommend the program to other ENDS users. Conclusions: Practitioners and patients enhanced their knowledge of e-cigarettes and their harm to health. In addition, practitioners demonstrated their ability to implement the RAKE cessation program within the practice, and patients approved of the use of the program. This study illustrated the feasibility and acceptability of conducting an e-cigarette cessation study in dental practices and a critical need to develop and disseminate the program to young patients.

Primary Care Physician Perspectives on Recommending E-cigarettes to Smokers: a Best-Worst Discrete Choice Experiment.

BACKGROUND: Recent clinical trials suggest that e-cigarettes may be more effective for smoking cessation than traditional cessation aids, yet primary care physician (PCP) practices regarding e-cigarette recommendations for smokers have not been studied in-depth. OBJECTIVE: To identify factors influencing PCP recommendation of e-cigarettes for smoking cessation. DESIGN: Discrete choice experiment and survey. PARTICIPANTS: Florida PCPs. MEASURES: The survey included a discrete choice experiment in which PCPs indicated whether they would recommend e-cigarettes for each of 8 hypothetical patient profiles with the following contrasting characteristics: e-cigarette use, interest in approved cessation methods, smoking intensity, prior experience with approved cessation medications, quit intention, age, and comorbidity. Responses were summarized using descriptive statistics and standardized scores (SS). KEY RESULTS: The sample (n = 216) was predominately male (76%), white (66%), and non-Hispanic (78%), and most respondents had held their medical degree for 20+ years (77%). The response rate was 28.7%. Most PCPs thought e-cigarettes were at least somewhat effective for smoking cessation (66%) and lowering disease risk (65%); 31% perceived e-cigarettes to be equally/more effective than traditional cessation aids. PCPs were split regarding whether e-cigarettes were less (50%) or equally harmful (38%) as cigarettes. Yet, few were very confident in their ability to counsel patients on e-cigarettes risks (27%) or benefits (15%). PCPs recommended e-cigarettes in 27% of patient profiles they evaluated. The most important factors influencing the decision to recommend or not recommend e-cigarette were patients' prior use of nicotine replacement therapy with (SS = 0.22, 95% CI = 0.17-0.27) and without use of other medications for cessation (SS = 0.18, 95% CI = 0.13-0.23), and being middle age (50 years old) with chronic obstructive pulmonary disease (SS = 0.16, 95% CI = 0.10-0.23). CONCLUSIONS: Considering the increased patient use of e-cigarettes and increasing use for cessation, this study highlights the need for guidelines and education to aid PCPs' counseling of patients about e-cigarette use.

Experimental Test of the Educational Impact of the Newly Proposed FDA Graphic Cigarette Warnings Among U.S. Adults.

BACKGROUND: In August 2019, the U.S. Food and Drug Administration proposed a set of 13 new graphic warnings for cigarette packaging and advertisements. PURPOSE: We evaluated these warnings relative to text-only equivalents for their ability to educate the public regarding harms of smoking and influence outcomes associated with quitting. METHODS: In an experimental within-subjects design, U.S. adult nonsmokers, smokers, and dual smoker/electronic cigarette (e-cigarette) users (N = 412) recruited from an online internet platform evaluated the newly proposed graphic warnings and corresponding text-only warnings on understandability, perceived new knowledge, worry elicited about the content of the warning, discouragement from smoking, and encouragement to use e-cigarettes. RESULTS: Graphic warnings were generally rated as providing better understanding, more new knowledge, eliciting more worry about harms of smoking, and providing more discouragement from smoking relative to text-only warnings. CONCLUSIONS: The newly proposed graphic warnings could influence important responses to warnings associated with motivation to reduce smoking.

Identifying message themes to prevent e-cigarette use among youth and young adults.

In 2020, almost 20% of high school students reported current e-cigarette use. Mass media tobacco prevention campaigns are effective for preventing tobacco use among youth and young adults but selecting messages that will have maximum impact on the target audience is a significant challenge for campaign developers. This study describes the method for identification of potential messaging targets for a national anti-vape mass media campaign using criteria proposed by Hornik and Woolf in their health communication framework. A national sample of 15- to 24-year-olds (N = 1564) was recruited via an online panel in May 2020. Participants endorsed a series of vape-related attitudinal items. Items were considered potential message targets if they distinguished between the four vape use groups (current users, ever users, susceptible never-users, and non-susceptible never-users) and if less than 70% of respondents endorsed the anti-vape item response. The resulting items targeted five potential message themes, each forming a scale measured with three to four individual items. Message themes included social acceptability of vaping, anti-vape industry sentiment, independence from vaping, non-vaping identity, and perceived risk of harm. Findings were used to inform the development of truth® campaign messaging focused on reducing the prevalence of e-cigarette use among youth and young adults.