The effect of vaping cues in e-cigarette advertisements on normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes in Boston.

INTRODUCTION: E-cigarette advertising frequently involves vaping cues-hand to mouth motions and vapor-that physically resemble traditional cigarette smoking cues. There has been concern that these vaping cues could make cigarettes seem more frequently used and acceptable by society. This analysis examined whether exposure to vaping cues in e-cigarette ads influence descriptive and injunctive normative perceptions about cigarettes among young adults who use cigarettes and e-cigarettes (dual use). METHOD: Secondary analysis was conducted on an experiment that randomly exposed young adults living in Boston who dual used in the past-week to either 1) E-cigarette ads with vaping cues; 2) E-cigarette ads that edited out vaping cues; or 3) Beverage ads. Descriptive and injunctive normative perceptions about cigarettes were compared across participants who viewed e-cigarette ads with vaping cues versus those who viewed ads without vaping cues. RESULTS: Those who viewed e-cigarette ads with vaping cues had decreased perceptions that cigarette smoking was common compared to those who viewed e-cigarette ads without vaping cues. Exposure to e-cigarette ads with vaping cues also led to increased perceptions of other peoples' unfavorable views toward cigarette smoking in general and their own cigarette smoking. CONCLUSION: Contrary to renormalization concerns, vaping cues in e-cigarette ads increased anti-smoking normative perceptions among people who dual used in the past week. Further research is needed to examine the impact of vaping cues in e-cigarette ads on normative perceptions among those who don't smoke or quit smoking cigarettes.

Traditional Cigarette and Poly-Tobacco Use Are Associated with Medical Opioid Use in Rural Areas of the US.

INTRODUCTION: Medical prescriptions for opioids are higher in rural areas of the US as compared to urban areas. Tobacco use may also play a role in this process. This analysis examines the association between differing types of tobacco use and medical opioid use. METHODS: We analyze the relationship between tobacco product use and medical opioid use among the US general population living in rural (non-metropolitan) areas using the publicly available sample adult file 2019 National Health Interview Survey (NHIS) (n = 5028). Tobacco use was classified into the following categories: only using cigarettes, only using e-cigarettes/vapes, only using cigars, only using smokeless tobacco, or using two or more of the following products. We used a binary logistic regression, controlling for individual differences. RESULTS: Individuals who reported using only traditional cigarettes (and no other tobacco product, OR = 1.62, 95% CI: 1.31, 2.01), or who reported being a poly-tobacco users (OR = 2.13, 95% CI: 1.40, 3.22) had higher odds of medical opioid use in the last twelve months. CONCLUSION: Results suggest a link between tobacco use, particularly cigarette use and poly-tobacco use, and medical opioid use in rural communities. Clinical and structural level interventions need to be implemented in rural communities to reduce comorbid tobacco and opioid use.

Social determinants of flu vaccine uptake among racial/ethnic minorities in the United States.

Research on the social determinants of vaccine uptake often occur between racial/ethnic groups and not within groups. Though minoritized individuals face inequalities across the board, these are also not evenly distributed amongst minoritized individuals within groups. Using the National Health Interview Survey data, we examined disparities in flu vaccine uptake across racial/ethnic groups in the United States (US). We examined (a) NH (non-Hispanic) White (n = 32,655), (b) NH Asian (n = 2335), (c) NH African American (n = 5137), and (d) Hispanic (n = 5718) respondents who lived in the United States using the combined 2017 and 2018. We used multivariable logistic regression to predict flu vaccination (yes/no) both in models comparing racial/ethnic groups and within groups. Less than 50% of any of the four major racial/ethnic groups in the US received a flu vaccination in 2017-18. Flu vaccine uptake varied within racial and ethnic groups. These results suggest that increasing vaccination may require a complex, multi-faceted perspective that considers subgroups more directly.

Inequities in tobacco advertising exposure among young adult sexual, racial and ethnic minorities: examining intersectionality of sexual orientation with race and ethnicity.

OBJECTIVE: This study examined sexual orientation differences in encoded exposure to tobacco product ads and intersections with race and ethnicity. METHODS: We analysed data from young adults (18-24) from the US Population Assessment of Tobacco and Health Study in 2013 and 2014 (N=9110). First, we compared encoded exposure to cigarette, electronic cigarette (e-cigarette), cigar and smokeless tobacco ads between sexual minorities (lesbian/gay, bisexual and something else) versus heterosexual young adults. We then analysed encoded ad exposure across sexual orientation, racial and ethnic subgroups. Analyses controlled for demographic and tobacco use variables. RESULTS: Bisexual women had significantly higher prevalence of encoded exposure to cigarette and cigar ads compared with heterosexual women, and significantly higher prevalence of encoded e-cigarette ad exposure compared with both heterosexual and lesbian/gay women. There were no significant differences in encoded ad exposure between lesbian versus heterosexual women and between gay or bisexual men versus heterosexual men. Compared with heterosexual white counterparts, increased encoded ad exposures were reported by heterosexual black women (cigarette and cigar ads), black heterosexual men (cigar ads) and bisexual black women (cigarette and cigar ads). Compared with heterosexual non- Hispanic counterparts, increased encoded ad exposures were reported by bisexual Hispanic women (cigarette, e-cigarette and cigar ads) and heterosexual Hispanic men (cigarettes and cigar ads). CONCLUSION: Sexual minority women of colour and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads. Further research is needed to address the impact of tobacco ads among multiple minority individuals based on sex, sexual orientation, race and ethnicity.

Gendered Conceptions of Preconception Health: A Thematic Analysis of Men's and Women's Beliefs about Responsibility for Preconception Health Behavior.

Preconception health (PCH) focuses on taking steps before a pregnancy to safeguard the health of the woman and future baby. Although recommendations to improve PCH target all people of reproductive age, research shows most interventions and messages focus primarily on women, which may contribute to existing normative beliefs that women are more responsible for protecting children's health. In this study, we explore society's gendered expectations of responsibility for engaging in recommended PCH behaviors (i.e., avoiding smoking, drinking, and environmental toxins). An applied thematic analysis of online survey responses from U.S. men and women (N = 573) identified five main themes and related subthemes: body and health, shared responsibility, choice and moral obligation, gender stereotypes, and doubt and uncertainty. Both men and women frequently referenced biological connections between prospective parents and offspring as justification for PCH behaviors. When challenging PCH recommendations, respondents mentioned excessive control of women and men's secondary role in reproduction. Overall, gender stereotypes were more commonly expressed in relation to men yet reflected both traditional and contemporary male roles (i.e., as supporters, co-parents). When judging personal responsibility, women commonly viewed PCH behaviors as the 'duty of a good mother'. Implications for PCH communication research and practice are discussed.

Effects of Current and Enhanced Tobacco Corrective Messages on Smokers' Intention to Quit Smoking and Intention to Purchase Cigarettes.

INTRODUCTION: A federal court has ordered tobacco companies to issue corrective messages to address tobacco-related misperceptions. This study examined the effects of viewing current versus two enhanced versions of tobacco corrective messages on smokers' intention to quit smoking and intention to purchase cigarettes. METHODS: US adult smokers (N = 803) were randomly assigned to view (1) two current tobacco corrective messages (Current), (2) two corrective messages that include an industry deception statement (Industry Deception), or (3) two corrective messages with an industry deception statement and testimonials of people harmed by smoking (Industry Deception + Testimonial). Outcomes were pretest-posttest change in intentions to quit smoking and posttest intention to purchase cigarette measures. RESULTS: Intention to quit smoking increased significantly after viewing the Current corrective messages versus baseline. In addition, viewing the Industry Deception + Testimonial messages increased intention to quit smoking compared with the Current corrective condition and the Industry Deception condition. Hispanic smokers had increased intention to quit smoking and decreased intention to purchase cigarettes to a greater degree than non-Hispanic smokers in response to Industry Deception + Testimonial messages. There was no significant difference in intention to purchase cigarettes across conditions. CONCLUSIONS: Enhancing the current corrective statements by including an industry deception statement and testimonials may strengthen effects and contribute to remedying the effects of tobacco misinformation. IMPLICATIONS: Previous research has found that draft or proposed versions of tobacco industry corrective messages are effective in correcting beliefs and knowledge. However, studies have not examined how the current court-ordered corrective messages could change intention to quit smoking and intention to purchase cigarettes nor whether enhanced messages could perform better. Study findings suggest that the current corrective messages can increase smokers' intention to quit smoking beyond their baseline intention. More importantly, enhancing corrective messages by including an industry deception statement and testimonial was found to be more effective than current corrective messages. Findings can inform future iterations of tobacco correctives and strategies to reverse the effects of tobacco misinformation.

A method for assessing links between objectively measured food store scores and store & neighborhood favorability.

Worldwide, interest in research on methods to define access to healthy food at the local level has grown, given its central connection to carrying out a healthy lifestyle. Within this research domain, papers have examined the spatial element of food access, or individual perceptions about the food environment. To date, however, no studies have provided a method for linking a validated, objective measure of the food environment with qualitative data on how people access healthy food in their community. In this study, we present a methodology for linking scores from a modified Nutrition Environment Measures Survey in Stores (conducted at every store in our study site of Flint, Michigan) with perceptions of the acceptability of food stores and shopping locations drawn from seven focus groups (n = 53). Spatial analysis revealed distinct patterns in visiting and avoidance of certain store types. Chain stores tended to be rated more highly, while stores in neighborhoods with more African-American or poor residents were rated less favorably and avoided more frequently. Notably, many people avoided shopping in their own neighborhoods; participants traveled an average of 3.38 miles to shop for groceries, and 60% bypassed their nearest grocery store when shopping. The utility of our work is threefold. First, we provide a methodology for linking perceived and objective definitions of food access among a small sample that could be replicated in cities across the globe. Second, we show links between perceptions of food access and objectively measured food store scores to uncover inequalities in access in our sample to illustrate potential connections. Third, we advocate for the use of such data in informing the development of a platforms that aim to make the process of accessing healthy food easier via non-food retail based interventions. Future work can replicate our methods to both uncover patterns in distinct food environments and aid in advocacy around how to best intervene in the food environment in various locales.

Testing the Effect of Vapor in ENDS Public Service Announcements on Current Smokers and ENDS Users' Psychophysiological Responses and Smoking and Vaping Urge.

Electronic nicotine delivery systems (ENDS) are increasingly popular, especially among young adults. Many ENDS advertisements and anti-ENDS public service announcements (PSAs) contain portrayals of ENDS use and visible vapor. Though it is plausible that vapor would be processed in similar ways to traditional combustible cigarette smoking cues, this has not been consistently established. In a laboratory session, we assessed cognitive and emotional processing using psychophysiological measures (e.g., facial electromyography, heart rate, and skin conductance) among young participants who were either smokers only (N = 43) or dual users of ENDS and cigarettes (N = 28) as they viewed four anti-vaping PSAs depicting either vapor or no vapor. Self-report urge to smoke traditional cigarettes and urge to vape and recognition (encoding) of information within the PSAs were measured following each PSA. Orbicularis oculi activation (positive emotion), heart rate deceleration (cognitive resource allocation), recognition (encoding), and vaping urge were greater in the vapor-present condition relative to vapor-absent condition. Hence, the presence of vapor in anti-vaping PSAs activates the approach/appetitive motivational system indicated by greater positive emotion, cognitive resource allocation, and memory, but also greater vaping urge compared to PSAs absent in vapor. Recommendations for inclusion of vapor and design of anti-vaping PSAs are discussed.

Social Capital and Tobacco Retail Outlet Density: An Empirical Test of the Relationship.

PURPOSE: To examine the relationship between tobacco outlet density and social capital. PARTICIPANTS: Parents of at least one teen (N = 2734) in a representative sample of US households with teens (ages 13-16). DESIGN: Population-based, cross-sectional survey of a web panel of adolescent-parent pairs matched with spatial data for address to characterize household neighborhoods. SETTING: US households identified by latitude and longitude with a 50-ft random shift. MEASURES: Perceived social capital (trust and informal social control as reported by parents), tobacco outlet density (retailers per land area in 1/2-mile buffer around each household), neighborhood demographics (derived from American Community Survey), and parent demographics. ANALYSIS: Multivariable regression examined the relationship between tobacco outlet density and social capital controlling for household buffer and individual-level covariates, including correlates of social capital. RESULTS: Tobacco outlet density was inversely correlated with perceived trust in neighbors (B = -1.12, P = .0004), but not social control (B = 0.11, P = .731). CONCLUSION: This study is the first we are aware of to find that social capital is related to tobacco outlet density. The results imply that individuals with low social capital may benefit from policies regulating tobacco outlet density and may benefit from policies that address neighborhood inequality by increasing social capital and reducing poverty.

Web-Based Health Information Technology: Access Among Latinos Varies by Subgroup Affiliation.

BACKGROUND: There are significant health technology gaps between Latinos and non-Hispanic whites and between first- and second-generation Latinos. OBJECTIVE: This study aimed to examine disparities in Web-based health information-seeking behavior (HISB) and patient portal use among Latinos, taking into account nativity and subethnic affiliation. METHODS: We analyzed US-born, non-Hispanic whites and Latinos adults (N=49,259) and adult internet users (N=36,214) in the 2015 to 2016 National Health Interview Survey using a binary logistic regression controlling for individual difference level variables. Outcomes were internet use, HISB (health information-seeking online and using a chat group for health information), and patient portal use (using a computer to schedule an appointment, filling a prescription, and communicating with a provider). RESULTS: We found that US-born Mexicans (odds ratio [OR] 0.81, 95% CI 0.66-0.99), foreign-born Mexicans (OR 0.35, 95% CI 0.29-0.42), foreign-born Puerto Ricans (OR 0.62, 95% CI 0.44-0.87), foreign-born Central and South Americans (OR 0.42, 95% CI 0.33-0.53), and foreign-born other Latinos (OR 0.34, 95% CI 0.24-0.49) had lower odds of using the internet than US-born non-Hispanic whites. The relationship between subgroup affiliation and Web-based HISB varied by type of technology. US-born Mexicans (OR 0.77, 95% CI 0.66-0.9), foreign-born Mexicans (OR 0.51, 95% CI 0.43-0.61), foreign-born Central and South Americans (OR 0.53, 95% CI 0.43-0.64), and foreign-born other Latinos (OR 0.56, 95% CI 0.4-0.79) had lower odds of looking up health information online than US-born non-Hispanic whites. Controlling for age, sex, education, income to federal poverty level, and region, foreign-born Central and South Americans (OR 0.61, 95% CI 0.41-0.92) and foreign-born other Latinos (OR 0.26, 95% CI 0.1-0.68) had lower odds of filling a prescription using a computer than US-born non-Hispanic whites. Foreign-born Mexicans (OR 0.51, 95% CI 0.36-0.72) and foreign-born Central and South Americans (OR 0.7, 95% CI 0.5-0.99) have lower odds of emailing a health care provider than US-born non-Hispanic whites. Posthoc analyses were conducted among Mexican-Americans to see if age was significant in predicting Web-based HISB or other patient portal use. We found individuals aged 18 to 30 years had higher odds of using the internet (OR 3.46, 95% CI 2.61-4.59) and lower odds of looking up health information online (OR 0.75, 95% CI 0.58-0.96). A posthoc analysis was conducted among Mexican-Americans to see if nativity predicted Web-based HISB and patient portal use. We found that US-born individuals had higher odds (OR 52.9, 95% CI 1.2-1.93) of looking up health information online compared with foreign-born individuals. CONCLUSIONS: We found Latino subgroups do not use health information channels equally, and attempts to target Latinos should take ethnicity and nativity into account.

Speaking up about Lighting up in Public: Examining Psychosocial Correlates of Smoking and Vaping Assertive Communication Intentions among U.S. Adults.

Against a backdrop of increasing smoke-free policies, electronic cigarette use, and discussion about public health risks posed by smoking and vaping, this study examines psychosocial predictors of intentions to ask others not to use e-cigarettes (vape) and smoke - i.e., assertive communication intentions. A national sample of U.S. adults (n = 474) reported assertive communication intentions for public venues. Psychosocial correlates included perceived risks of exposure to secondhand smoke (SHSe) and secondhand vapor (SHVe), SHSe and SHVe attitudes, subjective norms, and perceived self-efficacy. Separate linear regression models were conducted for smoking and vaping assertive communication intention outcomes. Perceived risks and self-efficacy were associated with greater vaping and smoking assertive communication intentions; subjective norms were only significant for vaping assertive communication intentions. Although a majority of respondents indicated they were unlikely to intervene to voice objections about SHSe and SHVe in public venues, this study suggests that incidental or intentional messages and policies that influence perceptions of risk, norms, and efficacy could affect willingness to voice objections about others' vaping and smoking in public.

Gender Stereotypes and Preconception Health: Men's and Women's Expectations of Responsibility and Intentions to Engage in Preventive Behaviors.

Introduction As mounting evidence underscores the importance of both men and women taking steps before pregnancy to improve reproductive outcomes, public health priorities are shifting toward a more gender-inclusive program of promoting preconception health (PCH). This study examined whether prescriptive gender stereotypes, defined as men's and women's beliefs about PCH behavioral norms each gender should uphold, were positively associated with intentions to engage in behaviors to protect a future child's health. Methods Data came from a June 2017 online survey of 609 U.S. men and women ages 18-44. Two six-item scales of prescriptive same- and opposite-gender stereotypes were used to predict a six-item scale of intentions to engage in six recommended PCH behaviors (i.e., avoiding smoking, secondhand smoke, drinking, exposure to bisphenol A and pesticides, and preventing Zika infection). Multiple linear regression models also adjusted for demographic, socioeconomic, and health characteristics. Results Among both male and female respondents, PCH prescriptive gender stereotypes for men were rated significantly lower than those for women. Adjusting for covariates, stronger prescriptive same-gender stereotypes were associated with increased PCH intentions (men: B = 0.496, p < 0.001; women: B = 0.486, p < 0.001). Opposite-gender stereotypes were also positively associated with PCH intentions (men: B = 0.205, p < 0.001; women: B = 0.235, p < 0.001). Current every day smoking status (men and women), being uninsured (women only), and having children (women only) were also associated with lower PCH intentions. Conclusion Prescriptive gender stereotypes may play an important, yet slightly different, role in promoting PCH behavior among men and women.

Comparing the effects of organic, natural, and no additives labels on tobacco packaging between Lesbian, Gay, Bisexual (LGB) and heterosexual smokers.

INTRODUCTION: Previous research found that exposure to health-oriented language (e.g., natural, organic) on tobacco product packages is associated with reduced perceptions of harm and intention to purchase the product. However, how lesbian, gay, bisexual (LGB) individuals, who use tobacco products at a higher rate than heterosexual peers, respond to health-oriented labels has not yet been examined. This analysis examines whether responses to health-oriented labels differ between LGB persons and heterosexual individuals. METHODS: Secondary analysis was completed from an experimental study that exposed US adult smokers to a non-US cigarette (Study 1) or e-cigarette (Study 2) package that displayed either health-oriented language ('100% organic,' 'all natural' or 'no additives'), traditional marketing language ('fine quality,' 'premium blend' or '100% original') or no language. RESULTS: No significant differences were found between LGB smokers and heterosexual smokers in responses to cigarette packages with health-oriented labels (Study 1). However, LGB smokers had less favorable attitudes toward the e-cigarette product after viewing health-oriented labels (versus no language control label) while heterosexual smokers' attitudes did not differ across health-oriented and control labels (Study 2). In addition, LGB smokers had lower intention to purchase and vape e-cigarettes, and less favorable attitudes in response to health-oriented labels than heterosexual smokers. CONCLUSIONS: Findings suggest that LGB smokers process pro-tobacco messages differently than heterosexual smokers, and that product type (i.e., cigarette vs. e-cigarette) may be a factor to consider. Further research is needed to uncover underlying mechanisms.

Assertive communication about others' smoking and vaping in public venues: Results from a National Survey of US adults.

INTRODUCTION: This study describes prevalence and correlates of US adults' intentions to engage in assertive communication (i.e., speak up) about others' smoking and vaping in public venues. METHODS: Participants from a nationally representative online survey of 1551 US adults conducted October-December 2013 reported intentions to ask others not to smoke/vape in three types of public venues (restaurants, bars/casinos/nightclubs, and parks). We examined weighted prevalence of intentions and conducted weighted logistic regression. RESULTS: Fifty-two percent of participants reported being likely to ask someone not to smoke in at least one venue compared with 19% for vaping. Assertive communication intentions for smoking in restaurants (48%), bars/casinos/nightclubs (35%), and parks (32%) were higher than for vaping (16%, 14%, and 12%, respectively). Significant correlates of assertive communication intentions in one or more venues were current smoking status, ever trying e-cigarettes, gender, age, health status, political ideology, and party identification. CONCLUSIONS: US adults were more willing to ask others not to smoke than vape. Intentions to speak up about smoking and vaping differed by venue, demographics, and cigarette/e-cigarette use. These findings help establish an evidence base to inform policymakers in developing strategies to promote compliance with smoke-free and vape-free laws.

Effects of exposure to anti-vaping public service announcements among current smokers and dual users of cigarettes and electronic nicotine delivery systems.

INTRODUCTION: Anti-vaping public service announcements (PSAs) are intended to discourage vaping or use of electronic nicotine delivery systems (ENDS). However, vaping portrayals in PSAs may have unintended effects if they increase smoking or vaping urges. This study examined benefits and unintended effects of anti-vaping PSAs with vapor portrayals on smoking and vaping-related outcomes. METHODS: Young adult smokers (N = 171) and dual users (N = 122) aged 21-30 years were randomly assigned to view: 1) anti-vaping PSAs with vapor; 2) anti-vaping PSAs without vapor; 3) physical activity PSAs; or 4) anti-smoking PSAs with smoking cues. Outcomes were changes in vaping and smoking urges before and after viewing PSAs, post-test vaping and smoking intentions in the next hour, and post-test intention to purchase ENDS and traditional cigarettes. RESULTS: Smokers only: Exposure to anti-vaping PSAs with vapor (vs. physical activity) was associated with lower intention to vape and to purchase ENDS (ps < 0.001) and lower intention to smoke and purchase cigarettes (ps < 0.05). Exposure to anti-vaping PSAs with vapor (vs. PSAs without vapor and vs. anti-smoking PSAs with smoking cues) was associated with lower intention to vape in the next hour (ps < 0.05). Exposure to anti-vaping PSAs without vapor (vs. physical activity) was associated with lower change in vaping urge (p < 0.05) and intention to purchase ENDS (p < 0.001). Dual users: Exposure to anti-vaping PSAs without vapor (vs. anti-smoking PSAs) was associated with lower intention to purchase ENDS (p < 0.05). CONCLUSION: Viewing anti-vaping PSAs with vapor was not associated with unintended effects and may have benefits on reducing smoking and vaping-related outcomes.

Effects of health-oriented descriptors on combustible cigarette and electronic cigarette packaging: an experiment among adult smokers in the United States.

OBJECTIVE: Certain tobacco companies use health-oriented descriptors (eg, 100% organic) on product packaging and advertising of combustible cigarettes or electronic cigarettes (e-cigarettes) that create a 'health halo' around smoking and vaping. Previous observational research suggests that such language may be associated with more favourable attitudes and reduced risk perceptions toward these brands compared with others. This study aimed to determine the effects of health-oriented descriptors on smokers' attitude toward the brand, perception of packaging information, comparative harm versus other brands and intention to purchase either combustible cigarettes or e-cigarettes. METHOD: US adult smokers were randomly assigned to view either a health-oriented language package ('100% organic,' 'all natural' or 'no additives'), traditional marketing language package ('fine quality,' 'premium blend' or '100% original') or a no-language package of a combustible cigarette brand (Study 1, n=405) or an e-cigarette brand (Study 2, n=396) in an experimental design. RESULTS: Study 1: Participants in the health-oriented condition reported more favourable perceptions toward the package information, lower comparative harm and higher intention to purchase combustible cigarettes versus the no language control. In addition, participants in the health-oriented condition reported more positive attitude toward the brand and lower comparative harm versus the traditional marketing condition. Study 2: Compared with the traditional marketing condition, participants in the health-oriented condition reported greater intention to purchase Absolute e-cigarettes. There were no significant differences in attitude toward the brand, perception of packaging information and comparative harm versus other brands across conditions. CONCLUSIONS: The effect of health-oriented language was significant for combustible cigarettesand e-cigarette packages. Policies to restrict health-oriented language on cigarette and e-cigarette packaging are recommended.

Knowledge about Chemicals in e-Cigarette Secondhand Vapor and Perceived Harms of Exposure among a National Sample of U.S. Adults.

Potentially harmful chemicals are detectable in e-cigarette secondhand vapor (hereafter SHV), contrary to advertising and marketing claims that it contains "only water vapor." We assessed public knowledge about the presence of chemicals in SHV and associations between knowledge and perceived harms of exposure to SHV. We conducted an online survey of a nationally representative sample of 1,449 U.S. adults (GfK's KnowledgePanel) from October to December 2013. Respondents were asked whether e-cigarette vapor contains only water vapor, contains tar, or contains formaldehyde (true/ false/ do not know). Responses to these three items were recoded (1 = incorrect, 2 = do not know, and 3 = correct) and averaged into a knowledge scale. They were also asked if they perceived breathing SHV to be harmful to one's health (two-item scale) and comparative harm of breathing SHV versus breathing secondhand smoke (SHS). Multiple regression analyses were weighted to the U.S. adult population and adjusted for potential confounders. Most respondents (58-75%) reported not knowing whether SHV contained only water vapor, if SHV contained tar, and if it contained formaldehyde. African-American respondents (vs. white) and current smokers (vs. nonsmokers) had lower levels of knowledge about chemicals in SHV. Adjusting for covariates, correct knowledge about chemicals in SHV was associated with higher perceived harms about SHV for one's health and perceived comparative harm of SHV versus SHS. These findings suggest a need to provide accurate information about the presence of chemicals in SHV (e.g., using product ingredient labels or public education).

To Regulate or Not to Regulate? Views on Electronic Cigarette Regulations and Beliefs about the Reasons for and against Regulation.

BACKGROUND: Policies designed to restrict marketing, access to, and public use of electronic cigarettes (e-cigarettes) are increasingly under debate in various jurisdictions in the US. Little is known about public perceptions of these policies and factors that predict their support or opposition. METHODS: Using a sample of US adults from Amazon Mechanical Turk in May 2015, this paper identifies beliefs about the benefits and costs of regulating e-cigarettes and identifies which of these beliefs predict support for e-cigarette restricting policies. RESULTS: A higher proportion of respondents agreed with 8 different reasons to regulate e-cigarettes (48.5% to 83.3% agreement) versus 7 reasons not to regulate e-cigarettes (11.5% to 18.9%). The majority of participants agreed with 7 out of 8 reasons for regulation. When all reasons to regulate or not were included in a final multivariable model, beliefs about protecting people from secondhand vapor and protecting youth from trying e-cigarettes significantly predicted stronger support for e-cigarette restricting policies, whereas concern about government intrusion into individual choices was associated with reduced support. DISCUSSION: This research identifies key beliefs that may underlie public support or opposition to policies designed to regulate the marketing and use of e-cigarettes. Advocates on both sides of the issue may find this research valuable in developing strategic campaigns related to the issue. IMPLICATIONS: Specific beliefs of potential benefits and costs of e-cigarette regulation (protecting youth, preventing exposure to secondhand vapor, and government intrusion into individual choices) may be effectively deployed by policy makers or health advocates in communicating with the public.

Online Health Information-Seeking Behavior and Confidence in Filling Out Online Forms Among Latinos: A Cross-Sectional Analysis of the California Health Interview Survey, 2011-2012.

BACKGROUND: Health information is increasingly being disseminated online, but there is a knowledge gap between Latinos and non-Hispanic whites, particularly those whose English language proficiency is poor, in terms both of online health information-seeking behavior and computer literacy skills. This knowledge gap may also exist between US- and foreign-born Latinos. OBJECTIVE: The specific aim of this study was to examine Internet use, online health information-seeking behavior, and confidence in filling out online forms among Latinos, particularly as it relates to health-risk behaviors. We then stratified our sample by nativity. METHODS: We used the adult population file of the 2011-2012 California Health Interview Survey, analyzing Internet use, online health information-seeking behavior, and confidence in filling out online forms using binary logistic regression among Latinos and whites (N=27,289), Latinos (n=9506), and Latinos who use the Internet (n=6037). RESULTS: Foreign-born Latinos (OR 0.71, 95% CI 0.58-0.88, P=.002) have lower odds of engaging in online health information-seeking behavior, and higher odds (OR 2.90, 95% CI 2.07-4.06, P<.001) of reporting a lack of confidence in filling out online forms compared to US-born Latinos. Correlates of online health information-seeking behavior and form confidence varied by nativity. CONCLUSIONS: Latinos, particularly foreign-born individuals, are at an increased risk of being left behind as the move to increase online content delivery and care expands. As online health information dissemination and online health portals become more popular, the impact of these sites on Latino gaps in coverage and care should be considered.