Concurrent Use of Tobacco and Cannabis and Internalizing and Externalizing Problems in US Youths.

Importance: Little is known about whether concurrent use of tobacco and cannabis is associated with higher or lower levels of mental health problems than use of either substance alone among youths. Objective: To examine the association between concurrent use of tobacco and cannabis and mental health problems in a national sample of US youths. Design, Setting, and Participants: This cross-sectional study analyzed publicly available wave 6 data within the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative cohort study of US youths aged 14 to 17 years, collected from March to November 2021. This analysis used wave 6 single-wave weights to obtain statistically valid estimates for cross-sectional analyses generalizable to the wave 4 cohort sample. Data were analyzed from November 15, 2023, to April 20, 2024. Exposure: Past 30-day use of any tobacco and cannabis products was self-reported and categorized into 4 exclusive patterns: concurrent, tobacco only, cannabis only, and nonuse. Main Outcomes and Measures: Self-reported past-year internalizing and externalizing mental health problems were measured using the modified version of the Global Appraisal of Individual Needs-Short Screener and separately categorized into 3 levels: low (0-1 symptoms), moderate (2-3 symptoms), and high (≥4 symptoms). Results: A total of 5585 youths were included in the study, with a weighted proportion of 51.3% being male and 72.5% aged 15 to 17 years. In terms of race and ethnicity, 1606 youths (25.7%) were Hispanic, 626 (12.7%) were non-Hispanic Black, 2481 (50.5%) were non-Hispanic White, and 555 (11.0%) were non-Hispanic other. The prevalence of concurrent use (3.4% [95% CI, 2.9%-4.0%]) was comparable to tobacco-only use (3.9% [95% CI, 3.2%-4.6%]), but greater than cannabis-only use (2.5% [95% CI, 2.1%-2.9%]). High levels of internalizing and externalizing problems were most common for the concurrent use group (internalizing: 47.4% [95% CI, 39.2%-55.9%]; externalizing: 61.6% [95% CI, 54.1%-68.7%]), followed by the cannabis-only use group (internalizing: 44.8% [95% CI, 35.7%-54.1%]; externalizing: 48.5% [95% CI, 39.1%-57.9%]), the tobacco-only use group (internalizing: 41.4% [95% CI, 33.7%-49.5%]; externalizing: 46.3% [95% CI, 38.3%-54.5%]), and the nonuse group (internalizing: 22.4% [95% CI, 21.1%-23.8%]; externalizing: 30.4% [95% CI, 28.9%-31.9%]). After controlling for covariates in ordinal logistic regression models, concurrent use of tobacco and cannabis was associated with greater odds of reporting higher levels of externalizing problems compared with tobacco-only use (adjusted odds ratio [AOR], 1.83 [95% CI, 1.15-2.91]) and cannabis-only use (AOR, 1.85 [95% CI, 1.11-3.06]). However, there were no statistically significant differences in the odds of internalizing problems between concurrent use and use of tobacco or cannabis alone. Conclusions and Relevance: In this cross-sectional study of the PATH Study wave 6 youth data, concurrent use of tobacco and cannabis was linked to higher levels of externalizing mental health problems than use of single substances, indicating a potential need to combine mental health support with tobacco and cannabis cessation interventions for youths.

Association between E-Cigarette Advertising Exposure and Use of E-Cigarettes among a Cohort of U.S. Youth and Young Adults.

Youth and young adult (YYA) use of e-cigarettes increased rapidly between 2010 and 2019 in the United States, during which exposure to e-cigarette advertising was also increased. We aimed to examine whether exposure to e-cigarette advertising among YYAs may lead to subsequent e-cigarette use. A cohort of 3886 YYAs ages 13-24 was recruited from two survey panels in 2018 and followed up until 2019. Survey data were collected online and by telephone. The primary outcome was past 30-day use of e-cigarettes at the follow-up survey. Among 2304 YYAs who retained at the follow-up survey and were not past 30-day e-cigarette users at baseline, both youth and young adults exposed to e-cigarette advertising at baseline had elevated odds of past 30-day e-cigarette use at follow-up (Youth adjusted odds ratio (aOR): 2.77, 95% CI: 1.23, 6.24; Young adults aOR: 2.34, 95% CI: 1.08, 5.11) compared with those not reporting baseline advertising exposure. The majority of YYAs reported exposure to e-cigarette advertising at baseline (Youth: 63.7%, 95% CI: 59.8, 67.4; Young adults: 58.3%, 95% CI: 53.6, 62.8). Our findings suggest that exposure to e-cigarette advertising was associated with an increase in subsequent past 30-day use of e-cigarettes among YYAs. Restricting advertising targeted at YYAs may reduce the likelihood of e-cigarette use among YYAs.

Associations between COVID-19 risk perceptions and smoking and quitting behavior among U.S. adults.

OBJECTIVES: The COVID-19 pandemic may impact cigarette smokers' behaviors. Among smokers, perceptions about the risks of contracting COVID-19 and the severity of COVID-19 illness likely vary, and perceptions may be associated with individual smoking behavior. Our study measured smokers' perceptions of COVID-19 risks and their association with smoking and quitting outcomes. METHODS: A sample of 1,223 U.S. adult cigarette smokers participated in an online survey in October-November 2020 to assess their COVID-19-related risk perceptions and changes in smoking, readiness to quit, and quit attempts during the COVID-19 pandemic. RESULTS: More smokers believed smoking could increase the severity of COVID-19 (43.6%, 95% CI: 40.1, 47.3) than believed smoking makes them more susceptible to COVID-19 (20.0%, 95% CI: 17.2, 23.0.). While there were no associations between perceptions of COVID-19 susceptibility and smoking behaviors or intentions, perceptions of greater smoking-related COVID-19 severity were associated with both higher likelihood of smoking increases (aOR: 2.16, 95% CI: 1.19, 3.93) and greater readiness to quit smoking (aOR: 1.65, 95% CI: 1.18, 2.30). Greater perceptions of general COVID-19 severity were associated with higher likelihood of smoking reductions (aOR: 1.12, 95% CI: 1.02, 1.22), greater readiness to quit smoking (aOR: 1.14, 95% CI: 1.07, 1.22), and higher likelihood of making a quit attempt (aOR: 1.12, 95% CI: 1.04, 1.22). CONCLUSIONS: Smokers' perceptions about COVID-19 severity are related to their smoking behavior and likelihood of making a quit attempt. Providing smokers with accurate information on the relationship between smoking and the severity of COVID-19 may alter smoking behaviors.

Prevalence of Diabetes and Prediabetes among Children Aged 11-14 Years Old in Vietnam.

AIM: Diabetes in children is becoming more prevalent in some countries. However, in most countries, little is known about the epidemiology of this disease. This study is aimed at estimating the prevalence of type 1 and type 2 diabetes and prediabetes among children in Vietnam and examining factors associated with the conditions. METHODS: A total of 2880 students aged 11-14 years old were recruited for the survey, using a school-based and nationally representative sampling frame. Capillary blood samples of participants were collected to measure fasting glucose level, using glucose meter OneTouch Verio Pro+. Diabetes and impaired fasting plasma glucose were initially diagnosed based on the cut-off points of the American Diabetes Association criteria. Diabetes status and type of diabetes of participants were confirmed at a hospital. Additionally, anthropometric and blood pressure measurements were conducted following a standardized procedure. Multivariate logistic regression was used to examine the association between outcome and independent variables. RESULTS: The overall prevalence of diabetes among the participants was 1.04‰ (three cases), with 2 cases (0.75‰) diagnosed with type 1 diabetes (one known and one newly diagnosed) and 1 case newly diagnosed with type 2 diabetes (0.35‰). The prevalence of impaired fasting glucose was 6.1%. Body mass index, place of residence, and age were found to be significantly associated with the impaired fasting glucose condition in participants. CONCLUSION: The prevalence of type 1 and type 2 diabetes in children in Vietnam is lower than that in some other countries reported recently. However, there is a high prevalence in impaired fasting glucose, requiring attention from policymakers to take action to prevent the occurrence of the epidemic of type 2 diabetes in children in the future.