Characteristics Associated with Ice Flavor Use among Middle and High School Students Currently Using E-cigarettes: National Youth Tobacco Survey, 2023.

PURPOSE: To examine ice flavor use and its correlates among middle and high school students who currently (any past 30-day) used e-cigarettes. METHODS: The 2023 National Youth Tobacco Survey (NYTS) assessed for the first time the use of e-cigarette flavors that included the word "ice" or "iced" in the name. Using logistic regression, data from the 2023 NYTS were used to examine differences in sociodemographic characteristics and tobacco use behaviors by ice flavor use among students who currently used e-cigarettes (n=1,565). RESULTS: Among middle and high school students who currently used e-cigarettes, an estimated 1.1 million or 57.9% reported ice flavor use. Youth who currently used e-cigarettes were more likely to use ice flavors if they used e-cigarettes on ≥20 of the past 30 days compared to 1-5 days (adjusted Odds Ratio [aOR]=2.31, 95% CI: 1.36-3.94); used fruit (aOR=2.27, 95% CI: 1.36-3.80), candy (aOR=2.73, 95% CI:1.54-4.82), or mint flavors (aOR=3.63, 95% CI:1.98-6.65) compared to those who did not use the respective flavor type; reported any nicotine dependence compared to those who did not (aOR= 1.71, 95% CI:1.04-2.80); or had mild/moderate (aOR=1.97, 95% CI: 1.01-3.83) or severe psychological distress (aOR=2.41, 95% CI: 1.25-4.62) compared to those without psychological distress. CONCLUSIONS: The present study found that ice-flavored e-cigarette use among youth was associated with use of e-cigarettes on ≥20 days, use of fruit, candy, or mint flavors, any symptoms of nicotine dependence, and psychological distress (mild/moderate, severe). Emergence of novel flavor categories and features of e-cigarettes warrant continued surveillance to provide an understanding of associated use patterns, especially among youth. IMPLICATIONS: This study examined ice flavor use and its correlates among middle and high school students who currently used e-cigarettes. Ice-flavored e-cigarette use among youth was positively associated with frequent e-cigarettes use, use of fruit, candy, or mint flavors, and any symptoms of nicotine dependence. Additionally, the likelihood of ice-flavored e-cigarette use was associated with severity of psychological distress.

An Analysis of Tobacco and Marijuana Use by Middle School and High School Bisexual and Homosexual Students Surveyed by the National Youth Tobacco Survey From 2020 to 2022.

OBJECTIVES: This study aimed to analyze tobacco and marijuana use by middle and high school students identifying as bisexual, gay, lesbian, or heterosexual using data from the National Youth Tobacco Survey (NYTS) spanning from 2020 to 2022. By comparing substance use patterns among different sexual orientation groups, the study sought to identify disparities and potential socioeconomic factors influencing these behaviors. METHODS: Data from the 2020 to 2022 NYTS were analyzed, focusing on responses regarding ever use of cigarettes, e-cigarettes, and marijuana by students of varying sexual orientations. Descriptive statistics and chi-square tests were employed to analyze differences in substance use and socioeconomic indicators between sexual orientation groups. RESULTS: Of the 37 541 students included in the analysis, significant differences in substance use were observed among bisexual, gay, lesbian, and heterosexual students. Bisexual and gay/lesbian students exhibited higher rates of ever use of cigarettes, e-cigarettes, and marijuana compared to heterosexual students. In addition, socioeconomic differences, such as lower rates of family vehicle ownership and reduced access to vacations, were noted among bisexual and gay/lesbian students. CONCLUSIONS: The findings underscore significant differences in tobacco and marijuana use by adolescents based on sexual orientation, mirroring differences observed in LGBTQ adults. These results highlight the importance of targeted interventions, educational initiatives, and support systems tailored to the unique needs of LGBTQ youth. Addressing socioeconomic disparities and fostering inclusive environments are crucial steps in promoting the health and well-being of LGBTQ adolescents. Continued research and collaborative efforts are essential in mitigating health disparities and creating equitable environments for all adolescents.

Secondhand tobacco smoke exposure in homes and vehicles in youth: disparities among racial, and sexual and gender minorities.

Background: Secondhand smoke exposure (SHSe) among youth is a serious public health concern, leading to an increased risk of conditions such as asthma and respiratory infections. However, there is little research on SHSe among vulnerable populations, such as racial and sexual minorities. Understanding the factors associated with youth SHSe in homes and vehicles is crucial to developing better protective policies. Methods: This study utilized 2020 data from the National Youth Tobacco Survey, a representative sample of middle- and high-school students in the US. The primary outcomes were youth SHSe at home and while riding in a vehicle. Multinomial regression models were used to assess factors associated with SHSe. Results: The data included 9,912 students enrolled in grades 6 through 12 in the United States who reported never using any form of tobacco. Non-Hispanic Black students living with someone who does not use any form of tobacco products were significantly more likely to experience moderate [OR = 2.1 (1.1-3.9), p = 0.03] and severe [OR = 5.1 (2.2-11.7), p < 0.001] secondhand smoke exposure (SHSe) in homes compared to their non-Hispanic White counterparts. Heterosexual female students had lower odds of reporting moderate SHSe in the home compared to heterosexual males [OR = 0.7 (0.6-0.99), p = 0.02], whereas bisexual females had two-fold increased odds of severe SHSe in homes [OR = 2.0 (1.2-3.4), p = 0.01]. Conclusion: Significant efforts are needed to develop targeted interventions to reduce SHSe in homes and vehicles, particularly in these vulnerable populations.

Factors associated with intentions to quit vaping and quit attempts among Adolescents: A structural equation modeling approach.

OBJECTIVES: Previous youth tobacco research has identified multiple factors relating to intentions to quit vaping and quit attempts among current e-cigarette users in adolescents. The pathways in the complex associations with vaping cessation behaviors remain unclear. METHODS: Using data from the 2022 National Youth Tobacco Survey (NYTS) (grades 6-12), structural equation models (SEMs) are developed to examine the associations of social environment, vaping risk perceptions, e-cigarette marketing, vaping characteristics, and demographics with two outcome measures - intentions to quit vaping and past year quit attempts among current e-cigarette users. RESULTS: The national sample of current e-cigarette users (n = 2,701) consisted of 52.7 % females, 47.0 % non-Hispanic Whites, 80.1 % high school students, and 56.2 % heterosexual individuals. Among them, 70.2 % reported intentions to quit vaping and 66.3 % reported past year quit attempts. The protective factor for quit intentions was vaping risk perceptions (p < 0.001). Risk factors included e-cigarette marketing (p = 0.04), dual use of e-cigarettes and other tobacco products (p = 0.003), vaping due to feeling anxious or stressed (p = 0.01), vaping for nicotine buzz (p = 0.002), nicotine dependence (p = 0.02), identifying as Gay or Lesbian (p < 0.001), bisexual (p = 0.03), or Hispanic (p = 0.04). Similar associations were observed with quit attempts except that e-cigarette marketing, vaping due to feeling anxious or stressed, vaping dependence, and identifying as Hispanic were not significant. Besides, high vaping frequency (p < 0.001), grade level (p < 0.001) and not sure about sexual orientation (p = 0.01) were also negatively associated with quit attempts. CONCLUSIONS: This study provided insights into factors influencing vaping cessation outcomes among adolescent current e-cigarette users. Developing tailored vaping cessation programs based on these findings could enhance quit success.

Multiple Tobacco Product Use Among Youth E-Cigarette Users: National Youth Tobacco Survey, 2020.

PURPOSE: Limited information exists on multiple tobacco product use, particularly among youth. This study assessed the prevalence of current youth use of e-cigarettes with other tobacco products and their associated characteristics using 2020 National Youth Tobacco Survey data. METHODS: Prevalence estimates were calculated for current e-cigarette users, by multiple tobacco product use status and product combination. Demographic characteristics, e-cigarette use behaviors, age at first combustible tobacco use, and tobacco dependence symptoms were compared between current users of both e-cigarettes and combustible tobacco (dual users) and current exclusive e-cigarette users. RESULTS: In 2020, 61.1% of all current e-cigarette users reported exclusive e-cigarette use, and 38.9% used e-cigarettes with other tobacco products. Among those who used e-cigarettes with other tobacco products, 85.0% used combustible tobacco, with cigarettes being the most commonly used other tobacco product. Compared with current exclusive e-cigarette users, higher proportions of dual users reported the following: frequent e-cigarette use; obtaining e-cigarettes from gas stations, persons other than a family member/friend, vape shops, or the internet; and having any tobacco dependence symptoms. Among dual users, 31.2% reported first combustible product use after e-cigarette initiation, and 34.3% reported first combustible product use prior to e-cigarette initiation. DISCUSSION: Approximately four in 10 youth current e-cigarette users reported using multiple tobacco products, with a majority using combustible tobacco. Frequent e-cigarette use and tobacco dependence symptoms were more prevalent among dual users of e-cigarettes and combustible tobacco.

An Analysis of Nicotine Pouch Use by Middle School and High School Students Surveyed by the National Youth Tobacco Survey in 2021 and a Review of the Literature.

OBJECTIVES: The use of alternative nicotine products by middle and high school students is a growing concern due to industry marketing techniques, availability, and popularity of new products, and ambiguous nicotine concentrations. The 2021 National Youth Tobacco Survey (NYTS) provides information about the frequency, and characteristics of middle, and high school students who have used nicotine pouches. METHODS: The National Youth Tobacco Surveys provide important information about the frequency of use of tobacco and alternative nicotine products by a representative sample of students in schools in the United States. The 2021 survey included questions about the use of nicotine pouches/dissolvable tobacco products. The results from the survey were analysis using descriptive statistics, and logistic regression to model the association between the use of these alternative nicotine products, and the use of electronic cigarettes or the use of conventional cigarettes. RESULTS: A total of 20 413 students participated in the survey year 2021; 17 842 were included in the final data analysis. Their ages ranged from 9 to 18+. Identified risk factors for the use of alternative nicotine products included race, and age. The adjusted odds ratio (OR) was lower in non-Hispanic Black and Hispanic students, as compared to non-Hispanic White students. Older students had a substantially higher risk of using nicotine/dissolvable tobacco products, specifically, compared to students less than or equal to 13 years old. The OR increased 174% (OR: 2.74; 1.70-4.41) in 17-year-old students. The perception of harm associated with electronic cigarettes increased the likelihood of using alternative nicotine products. Students who did not smoke cigarettes (OR: 0.39; 0.27-0.56) or did not smoke electronic cigarettes (OR: 0.20; 0.18-0.40) had significantly lower OR for using alternative nicotine products. CONCLUSIONS: The 2021 National Youth Tobacco Survey indicates that a relatively small percentage of middle school and high school student have used nicotine pouches. However, with the increase in new, alternative tobacco products, understanding adolescent use in comparison to other tobacco products is an important trend to monitor.

Electronic cigarette use by and perceptions of middle and high school students in the United States.

Electronic cigarettes (e-cigarettes) provide a novel source of nicotine and may lead to experimentation by adolescents and eventually to their use of conventional cigarettes. The National Youth Tobacco Survey collected information from a nationally representative sample of students in 2016 to determine their experiences with conventional cigarettes and e-cigarettes, their intentions to use these products in the future, and their perceptions of harm and addiction associated with these products. We analyzed these data with ordered probit regression models to determine possible associations with the intention to try e-cigarettes and conventional cigarettes. This survey included 20,520 respondents, 50.6% were male, 5.9% had used conventional cigarettes, and 9.0% had used e-cigarettes. Approximately 10% thought e-cigarettes caused no harm, 3.7% thought that conventional cigarettes caused no harm, and 52.5% thought that e-cigarettes were less harmful than conventional cigarettes. Less than 1% of the students responded "Definitely yes" to the question, "Do you think you will try an e-cig?" The odds ratios for an intention to try e-cigarettes increased as the perception of harm decreased; these ratios increased from 1.0 for "A lot of harm" to 5.85 (95% CI: 3.51, 9.75) for "No harm." In 2016, the majority of students thought that e-cigarettes could cause some harm. This survey indicates that most students have not tried e-cigarettes or conventional cigarettes. The minority of students who think that e-cigarettes pose no harm and students in the ages 14 and 16 are more likely to try them.

Symptoms of tobacco dependence among middle and high school tobacco users - Data from the 2019-2020 National Youth Tobacco Survey.

INTRODUCTION: Previous studies have indicated that youth who use tobacco products, including cigarettes, cigars, and smokeless tobacco, demonstrate dependence symptoms. However, the tobacco marketplace has expanded dramatically in recent years, and few studies have examined dependence symptoms among youth who use novel products. This study combined 2019-2020 National Youth Tobacco Survey data to report the prevalence and determinants of tobacco dependence symptoms among U.S. middle and high school current (past 30-day) tobacco users. METHODS: Prevalence estimates were calculated to examine dependence outcomes and other covariates by user groups (single product users and multiple product users). Multivariable logistic regression analyses were used to identify independent predictors of tobacco dependence among current users of cigarettes, cigars (regular cigars, cigarillos, and little cigars), e-cigarettes, heated tobacco products, hookah, pipe tobacco, bidis, and smokeless tobacco products (chew, snuff, dip, snus, and dissolvables). RESULTS: Among current tobacco users, 15.7 % (95 % CI: 14.2-17.3) reported wanting to use tobacco within 30 min of waking and 28.3 % (95 % CI: 26.3-30.5) reported strong cravings for tobacco in the past 30 days. Nearly-two-thirds of current users were single product users, of which 80.5 % reported using e-cigarettes. Reporting of dependence symptoms was generally associated with multiple product use, higher frequency of use, earlier initiation age, and use of flavored products. CONCLUSIONS: Among U.S. adolescents, a considerable amount of current tobacco product users, even infrequent users, reported symptoms of dependence. These findings highlight the continued importance of prevention strategies for youth tobacco experimentation and progression to regular use.

Impact of Survey Setting on Current Tobacco Product Use: National Youth Tobacco Survey, 2021.

PURPOSE: To examine whether survey setting was associated with youth reporting of current (past 30-day) use of any tobacco product, e-cigarettes, cigarettes, and cigars. METHODS: Data from the 2021 National Youth Tobacco Survey (NYTS) were used to estimate the prevalence of current use of any tobacco product, e-cigarettes, cigarettes, and cigars by survey setting, sociodemographic characteristics, peer tobacco use, and other tobacco product use. Multivariable regression was used to test the impact of survey setting on current tobacco use. Tobacco access sources among current users were compared by survey setting. RESULTS: Among students who participated in the 2021 NYTS, 50.8% reported taking the survey on school campus and 49.2% at home/other place. The prevalence of current use of any tobacco product, e-cigarettes, cigarettes, and cigars was higher among students completing the survey on school campus than at home/other place. After adjusting for covariates, this association persisted only for current use of any tobacco product (adjusted odds ratio = 1.57; 95% confidence interval, 1.28-1.91) and e-cigarettes (adjusted odds ratio = 1.43; 95% confidence interval, 1.20-1.71). Current users reported similar sources of access to tobacco products, regardless of survey setting. DISCUSSION: The likelihood of youth reporting current use of any tobacco product and e-cigarettes differed by survey setting. Such differences could be due to lack of privacy at home, peer influence in school settings, and other unmeasured characteristics. Methodological changes were made due to COVID-19; caution is warranted in comparing results from the 2021 NYTS with those of previous or future NYTS conducted primarily on school campus.

Tobacco Use, Dependence, and Age of Initiation among Youths with Cognitive Disability.

OBJECTIVES: To examine the prevalence of tobacco use by product type among youths with cognitive disability; the prevalence of tobacco dependence among youths with cognitive disability; and the relationship between age of tobacco use initiation and cognitive disability. STUDY DESIGN: This cross-sectional study analyzed data from the 2019 National Youth Tobacco Survey (NYTS). Participants were a nationally representative sample of 19 018 students in grades 6-12. Estimates were calculated for ever use, current use, age of tobacco use initiation, and tobacco dependence. Associations between use patterns and cognitive disability status were examined using bivariate analyses and multivariable logistic regression. RESULTS: Compared with youths without cognitive disability, youths with cognitive disability had significantly greater odds of ever using any tobacco product (aOR, 1.49; 95% CI, 1.31-1.70), currently using any tobacco product (aOR, 1.41; 95% CI, 1.26-1.58), and currently using electronic cigarettes (e-cigarettes), cigarettes, cigars, hookahs, roll-your-own cigarettes, and heated tobacco products, specifically. They had higher prevalence and odds of reporting younger age of tobacco use initiation (aOR, 1.25; 95% CI, 1.10-1.43). Higher prevalence and odds of tobacco dependence were also observed among youths with cognitive disability compared with youths without cognitive disability (P < .001). CONCLUSIONS: These findings reinforce the importance of developing early primary prevention efforts to reduce or delay tobacco use among adolescents with cognitive disability. They also suggest the need to address co-occurring disorders during tobacco cessation programs with this high-risk group.

The consequential impact of JUUL on youth vaping and the landscape of tobacco products: The state of play in the COVID-19 era.

JUUL is a groundbreaking electronic cigarette (e-cig) and the preeminent vaping product on the market. We present an overview of the rapid and spectacular rise of JUUL and its remarkable fall within the timespan of 2015 - 2020. We highlight JUUL's entering the market in June 2015, becoming the industry leader in mid 2017, and experiencing a litany of setbacks by late 2019 through to early 2020. We address the role played by JUUL in the ongoing epidemic of youth vaping. We also feature competing views on the public health impact of JUUL use (in particular), and e-cig vaping (in general). We further highlight the latest trends in youth vaping and sales records for JUUL and tobacco cigarettes. In view of the ongoing pandemic of COVID-19, we briefly summarize the existing evidence on the relationship between vaping and smoking and the prevalence, disease course, and clinical outcomes of COVID-19.

Heated tobacco product use among US adolescents in 2019: The new tobacco risk.

INTRODUCTION: There is growing public health concern about adolescent use of heated tobacco products (HTPs) after the US Food and Drug Administration approved the leading HTPs, IQOS, as a modified risk tobacco product. Extending the previous studies examining the correlates of HTP use among adolescents, this study aims to investigate potential risk factors for HTP use among US adolescents, including the use of multiple tobacco and flavored tobacco products. METHODS: We analyzed the 2019 National Youth Tobacco Survey (n=19018) and conducted a series of logistic regression models on awareness and use of HTPs as a function of tobacco use status (none, single, dual/poly) and past 30 days flavored tobacco use (e.g. menthol cigarette use, flavored e-cigarettes), controlling for sociodemographics. RESULTS: In multivariable analyses, awareness of HTPs was associated with usual menthol cigarette use (AOR=1.77; 95% CI: 1.23-2.53) and past 30 days flavored tobacco use (AOR=1.44; 95% CI: 1.16-1.80). Risk factors for ever HTP use included single (AOR=2.52; 95% CI: 1.19-5.33) and dual/poly tobacco use (AOR=4.94; 95% CI: 2.56-9.54), usual menthol cigarette use (AOR=2.50; 95% CI: 1.66-3.76), and past 30 days flavored tobacco use (AOR=1.61; 95% CI: 1.07-2.44). Risk factors for current HTP use included single (AOR=10.84; 95% CI: 6.72-17.49) and dual/poly tobacco use (AOR=31.96; 95% CI: 17.79-57.43), and usual menthol cigarette use (AOR=2.50; 95% CI: 1.63-3.85). CONCLUSIONS: This study documents HTP use in adolescents and contributes insight and urgency into prioritizing at-risk adolescents for interventions, including current users of other tobacco products and flavored tobacco users.

Latent class trajectories: U.S. adolescents' nicotine use and its association with nicotine dependence.

INTRODUCTION: Twenty-seven percent of adolescents used a nicotine/tobacco product in 2018. Our study analyzed three waves from the Population Assessment of Tobacco and Health (PATH) Study and examined adolescent nicotine/tobacco use trajectories over time to determine which latent classes were associated with symptoms of nicotine dependence. METHODS: The PATH Study used a four-stage, stratified area probability sample and annual household interviews with adolescents (12-17 years). Adolescents who indicated past 30-day nicotine/tobacco use at least once were included (n = 1101). We used latent class analysis (LCA) to identify nicotine/tobacco trajectories across three waves of PATH data and their association with six symptoms consistent with nicotine dependence from the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68). RESULTS: All types of past 30-day nicotine/tobacco use increased across the three waves. An LCA model fit was assessed using both the CIV and entropy measures in conjunction with the Vuong-Lo-Mendell-Rubin LRT. A five latent class solution had the lowest BIC value (BIC = 9784.272), and resulted in: (1) "Stable/consistent multiproduct use trajectory", (2) "Increasing cigarette use trajectory", (3) "Increasing e-cigarette use trajectory", (4) "Experimental (poly-nicotine/tobacco) use trajectory", and (5) "Increasing other nicotine/tobacco use trajectory". The most prevalent was the "Experimental (poly-nicotine/tobacco) use trajectory" (33.8%) although sex, race, and social class were associated with different trajectories. Those represented by the "Increasing cigarette use trajectory" (19.4%) reported significantly more past-year nicotine dependence symptoms (b = 1.73, p < 0.001) compared to the "Increasing e-cigarette use trajectory". Findings varied by sex and race. CONCLUSIONS: Results indicate that the relationship between e-cigarette use and other forms of nicotine/tobacco and substance use is complex and that adolescent nicotine/tobacco users are a heterogenous group with different risks for nicotine dependence. Findings can inform tailored prevention education and messaging for different groups of youth.

Heated tobacco product use and associated factors among U.S. youth, 2019.

BACKGROUND: In April 2019, the U.S. Food and Drug Administration authorized the marketing of IQOS Heated Tobacco Products (HTPs) in the United States. This study sought to assess self-reported awareness and use of HTPs among U.S. students in 2019. METHODS: This study analyzed the 2019 National Youth Tobacco Survey (NYTS), a cross-sectional, school-based, nationally representative survey (n = 19,018). Weighted estimates of the prevalence of self-reported awareness, ever use, and current use (past 30-day) of HTPs were reported and multivariable logistic regression models were performed to examine the factors associated with HTPs awareness and use. RESULTS: In 2019, 12.8 % (a population estimate of 3,438,000), 2.4 % (632,000), and 1.6 % (425,000) of U.S. students reported awareness, ever use, and current use of HTPs, respectively. In the multivariate analysis, high school students were less likely than middle school students to report awareness (AOR = 0.7 [0.6-0.8]) of HTPs. Females (vs. males) had a lower odd of reporting ever use of HTPs (AOR = 0.5 [0.4-0.8]), while Hispanics (vs. non-Hispanic Whites) had higher odds of reporting current use of HTPs (AOR = 1.6 [1.1-2.5]). Current cigarette smoking, e-cigarette use, and other tobacco use are associated with higher odds of HTPs ever and current use than non-users. CONCLUSIONS: HTP use is emerging among U.S. adolescents. This study identified an elevated risk of HTP use among middle school students, Hispanics, current tobacco users, and those who live with a household member using HTPs. Continuous surveillance and educational campaigns on the harmfulness of HTPs are warranted.

Youth Access to Tobacco Products in the United States, 2016-2018.

OBJECTIVES: In 2018, approximately 4.9 million US middle and high school students reported past 30-day use of any tobacco product. This study describes how and where youth obtained tobacco products and whether refusal of sale occurred during 2016-2018. METHODS: Data from 3 annual waves (2016-2018) of the National Youth Tobacco Survey, a school-based survey of US youth in grades 6-12, were analyzed among current (past 30-day) tobacco product users aged 9 to 17 years. RESULTS: During 2016-2018, youth tobacco product users most commonly obtained tobacco products from social sources. Although the percentage of users who reported buying tobacco products significantly decreased from 2016 to 2018 (2016: 15.6%; 2018: 11.4%), no significant differences in the prevalence of being refused sale were observed (2016: 24.7%; 2018: 25.5%). CONCLUSIONS: Whereas the number of youth users who report buying tobacco products has declined, sales of tobacco products to youth remain a public health concern, as only one in 4 youth who attempted to buy were refused sale in 2018. Monitoring youth tobacco product purchases, retailer compliance check inspections, and retailer penalties for sales to minors remain important for reducing youth access at retail sources.

Harm Perceptions of Intermittent Tobacco Product Use Among U.S. Youth, 2016.

PURPOSE: We aimed to describe U.S. youth harm perceptions of intermittent tobacco use. METHODS: Using data from the 2016 National Youth Tobacco Survey of U.S. students (grades 6-12; N = 20,675), we examined prevalence and correlates of all respondents' perceived harm of using four different tobacco products on "some days but not every day." Associations between current (past 30-day) use and harm perceptions were assessed using multivariable regression. RESULTS: Perceiving that intermittent use causes "no" or "little" harm was 9.7% for cigarettes, 12.0% for smokeless tobacco, 18.7% for hookah, and 37.5% for e-cigarettes. Compared with those who reported "a lot" of harm, youth with lower harm perceptions were more likely to report current use. CONCLUSIONS: One in ten youth perceived intermittent cigarette smoking as causing "little" or "no" harm; this perception was higher among current users. Efforts to educate youth about the risks of even intermittent tobacco product use could reduce misperceptions of harm.

Secondhand smoke exposure at home among middle and high school students in the United States - does the type of tobacco product matter?

BACKGROUND: A decline in the prevalence of secondhand smoke (SHS) exposure has been observed in the United States of America (USA) during the past few decades. Nevertheless, nearly half of non-smoking students are still exposed to SHS. This paper aims to describe the factors associated with SHS exposure stratified by type of exposure (overall, cigarettes and electronic cigarettes). METHODS: The analysis is based on secondary data taken from the National Youth Tobacco Survey 2014. Overall, 22,007 middle and high school students from the USA are included in the sample. Descriptive and bivariate statistics as well as binary logistic regression models were performed. RESULTS: Overall, 44.5% (n=9,798) of the study participants declared themselves to be exposed to SHS, 29.1% (n=6,394) declared to be exposed to SHS caused by cigarette smoke and 9.4% (n=2,067) claimed that a person who lives with them uses electronic cigarettes. There is a considerable overlap between the two types of SHS exposure, because 74.9% (n=1,548) of students declaring that a person within their household uses electronic cigarettes also declare a person in the household smoking cigarettes. The strengths of association between independent variables and SHS exposure differs by type of exposure and also by smoking status of respondents. CONCLUSIONS: Although only small differences are obvious in the factors associated with SHS exposure stratified by the type of tobacco product, there are still some variations which should be considered in policy making to allow for a targeted approach in prevention campaigns or legislation.

Assessment of secondhand smoke exposure at school among U.S. Middle and high school students.

To obtain nationally representative estimates of the prevalence of secondhand smoke (SHS) exposure at U.S. schools, we assessed the prevalence and correlates of SHS exposure at school among U.S. middle and high school students using data from the 2011 National Youth Tobacco Survey comprising of 18,866 students spread across all the U.S. states. Overall prevalence of SHS exposure at school was 25.7% (95% CI: [23.6%, 27.8%]). Multivariate logistic regression indicated that having ≥1 smoker friends (adjusted Odds Ratio [aOR] = 2.92; p < .001); being a smoker (aOR = 2.75; p < .001); and being aged 13-16 years, or ≥17 years (vs. 9-12 years) significantly increased the likelihood of SHS exposure. Understanding the health risks of SHS exposure alone did not seem to play a significant role in reducing exposure (aOR = .89; p = .342). These findings show there are significant levels of SHS exposure among students at U.S. middle and high schools, and sustained multipronged efforts are needed to reduce youth SHS exposure.

Trends in exposure to pro-tobacco advertisements over the Internet, in newspapers/magazines, and at retail stores among U.S. middle and high school students, 2000-2012.

BACKGROUND: Most tobacco use begins during youth. Thus, this study assessed the prevalence, trends, and correlates of pro-tobacco advertising among United States students in grades 6-12 during 2000-2012. METHODS: Data from the 2000-2012 National Youth Tobacco Survey were analyzed to assess self-reported exposure to pro-tobacco advertisements through three media: over the Internet, in newspapers/magazines, and at retail stores. Trends during 2000-2012 were assessed in a binary logistic regression model (P<0.05). RESULTS: Among all middle and high school students, the overall prevalence of exposure to Internet pro-tobacco advertisements increased from 22.3% to 43.0% during 2000-2012 (P<0.001 for linear trend). During the same period, declines were observed in the overall prevalence of exposure to pro-tobacco advertisements in newspapers/magazines (65.0% to 36.9%) and at retail stores (87.8% to 76.2%) (P<0.001 for all linear trends). CONCLUSION: Exposure to pro-tobacco advertisements over the Internet increased significantly during 2000-2012 among United States middle and high school students, while a decline in exposure to advertisements in newspapers or magazines, and at retail stores occurred during the same period. However, over two-thirds of students still reported retail store exposure to pro-tobacco advertisements in 2012. Enhanced and sustained efforts would be beneficial to reduce even more exposure to all forms of pro-tobacco advertisements among youths.