Cigarette and e-cigarette use as a function of psychological distress following COVID-19 related university campus closures.

Background: Individuals experienced increased social isolation resulting from the COVID-19 pandemic. Studies have found social isolation and loneliness to be strongly associated with anxiety and depression, which have been associated with increased smoking and vaping rates among young adults, including college students.Objectives: To examine relationships between psychological distress and nicotine use within the context of the COVID-19 pandemic.Methods: A cross-sectional online survey (n = 4634; 77.9% female) was used to collect nicotine use and psychological measures from students enrolled at a large Midwestern university. Timeline follow-back data were collected from students reporting current cigarette or electronic cigarette (e-cigarette) use in the week before and immediately following the closure of campus due to the pandemic. Generalized estimating equations were used to examine the interaction between nicotine use and psychological symptoms across the 2-week period.Results: Both cigarette (Rate ratio (RR) = 1.115, 95% CI = 1.061, 1.171, p < .0001) and e-cigarette (ß = 0.258, 95% CI = 0.166, 0.351, p < .0001) use increased significantly following campus closure. Students experiencing higher levels of depression reported greater increases in e-cigarette use frequency over time as compared to students reporting fewer symptoms of depression (ß = 0.018, 95% CI = 0.006, 0.030, p = .004).Conclusions: Increases in nicotine use were found immediately following the implementation of public health safety measures that closed most university campuses. Additional and/or increased stressors have potentially impacted young adults who are college students as a result of campus closures resulting from the pandemic, which may have contributed to further increases in nicotine use.

Combined Working Memory Training and Transcranial Magnetic Stimulation Demonstrates Low Feasibility and Potentially Worse Outcomes on Delay to Smoking and Cognitive Tasks: A Randomized 2 × 2 Factorial Design Pilot and Feasibility Study.

INTRODUCTION: Repetitive Transcranial Magnetic Stimulation (rTMS) has shown promising results in treating several Substance Use Disorders including Tobacco Use Disorder. However, questions remain regarding how to optimize treatment outcomes. Enhancement of working memory by rTMS is a potential therapeutic mechanism. The current pilot study examined whether rTMS plus a cognitive training program could enhance the effects of rTMS on smoking behaviors using a controlled, factorial design. AIMS AND METHODS: We hypothesized that cognitive training plus stimulation would improve control over smoking behaviors, resulting in enhanced cognitive performance and increased latency to smoke on a delay to smoking analog task. Using a 2 × 2 factorial design, nicotine dependent smokers (n = 43) were randomized to receive 10 sessions of active (10 Hz) or sham rTMS delivered to the left dorsolateral prefrontal cortex, plus active or sham working memory training (WMT) prior to and following stimulation. RESULTS: Contrary to hypotheses, we observed a significant interaction effect, indicating that combining the two active interventions (rTMS+WMT) resulted in worse performance on the smoking analog task (B = -33.0, 95% CI = -64.39, -1.61, p < .05), compared to delivering either intervention alone. Additionally, although active rTMS (compared to sham rTMS) improved letter-sequencing performance (B = 1.23, 95% CI = 0.08-2.38, p < .05), and active WMT (compared to sham WMT) improved back-digit task performance (B = 1.53, 95% CI = 0.02-3.05, p < .05), combining interventions worsened the effect of each on a back-digit task (B = -3.01, 95% CI = -5.96, -0.052, p < .05). CONCLUSIONS: These preliminary findings indicate potential iatrogenic effects of combining rTMS and this working memory training intervention and underscore the need for rigorous evaluation of substance specific conceptual frameworks when selecting future combination interventions. IMPLICATIONS: Counter to hypothesis, this study found no additional benefit of adding a working memory training program to a rTMS protocol in a sample of daily smokers. The combination condition (active rTMS + active training) resulted in worse performance on a delay to smoking analog task and a measure of working memory performance compared to delivering either intervention alone. These preliminary findings inform strategies for optimizing rTMS in smokers and highlight the need for future studies to consider several key components of candidate combination interventions, including effects on regulation of substance use. CLINICAL TRIAL REGISTRATION (IF ANY): The trial was registered at ClinicalTrials.gov (NCT03337113).

Increases in Risky Drinking During the COVID-19 Pandemic Assessed via Longitudinal Cohort Design: Associations With Racial Tensions, Financial Distress, Psychological Distress and Virus-Related Fears.

BACKGROUND: The COVID-19 pandemic has created disruptions to daily life resulting in wide-spread unemployment and psychological distress. Recent studies have reported high rates of alcohol use during this time; however, longitudinal data remain scarce and factors associated with increases in high-risk drinking observed over time are unknown. AIMS: The current study examined changes in high-risk drinking patterns across four 7-day observation periods, prior to and following a university wide campus closure. Additionally, factors associated with changes in alcohol use patterns were examined including financial distress, psychological distress, impact of racial tensions and virus-related fears. METHOD: Students (N = 1001) in the Midwestern USA completed repeated assessments between March and June 2020. Each survey included a timeline follow-back measure of alcohol use. Pandemic-related distress spanning several factors was assessed at the final follow-up. RESULTS: Risky drinking patterns increased significantly over time. Overall, psychological distress and impact of racial tensions were associated with higher rates of risky drinking, whereas COVID-19-related fears were associated with lower rates. However, only financial-related distress was associated with an increase in risky drinking patterns over time. CONCLUSIONS: Increased risky drinking patterns observed in the current study may signal problems that are likely to persist even after the direct impact of the COVID-19 pandemic on daily life ends. Individuals experiencing financial distress may represent a particularly high-risk group. Interventions targeting the cross-section of job loss, financial stress and problematic alcohol use will be important to identify.

Effects of Negative Emotion on Abstinence Induced Change in Urge to Vape and Measures of Vaping Dependence.

INTRODUCTION: Negative emotion and craving to smoke are established factors driving the maintenance of combustible cigarette use and dependence. The current study aimed to examine whether these findings extend to e-cigarette use. Toward that aim, change in vaping urge following abstinence was examined as a function of negative emotion. Additionally, a mediation model which previously demonstrated relationships between negative emotion, craving, and combustible cigarette dependence was tested in e-cigarette users. METHOD: Daily e-cigarette users (N = 32, Mage = 21 years, SDage = 7 years; 78% white) completed a battery of psychological, behavioral, and smoking-related measures in a human laboratory setting. Using their personal devices, participants completed a 5-minute ad-libitum vaping session, a baseline measure of vaping urge, followed by a 2-hour observed abstinence period and a final assessment of vaping urge. RESULTS: Multivariate regression and two mediation models were utilized to examine factors associated with vaping dependence. The results of these models indicated that negative affect predicted vaping urge following observed abstinence. The relationship between negative affect and measures of vaping dependence and habit, respectively, were significantly mediated by changes in urge during the abstinence period. CONCLUSIONS: These preliminary results indicate that psychological constructs underlying vaping dependence are similar to those previously found to be associated with combustible cigarette dependence. Further research examining whether these constructs, namely negative affect and change in urge following abstinence, will be important variables to target for vaping cessation treatments is needed.

Effects of Negative Affect, Urge to Smoke, and Working Memory Performance (n-back) on Nicotine Dependence.

BACKGROUND: Three key domains including negative emotionality, incentive salience, and executive function form the core functional elements of addictive behaviors. Variables related to these broader domains have been studied extensively in relation to one another; however, no studies to date, have examined models including variables from all three domains, in relation to nicotine dependence. METHOD: Smokers (N = 117), 65.8% female, 78% white, mean age of 44.4 (SD = 10.8), enrolled in a smoking cessation program completed measures of negative affect (a component of negative emotionality), urge to smoke (incentive salience), and working memory (WM; a core executive function), during a baseline assessment period prior to initiating treatment. RESULTS: Negative affect was associated with greater urge to smoke, and this elevated urge to smoke was associated with higher levels of nicotine dependence. Further, a significant moderated mediation indicated that WM moderated the relationship between increased urge to smoke and nicotine dependence. For those with low to average WM, urge to smoke was significantly related to nicotine dependence; however, for those with higher WM (+1 SD), urge to smoke stemming from negative affect was not associated with nicotine dependence. CONCLUSIONS: To our knowledge, this is the first reported relationship between negative affect, urge to smoke, WM, and nicotine dependence. Although preliminary, results indicate that WM may moderate the relationship between urge to smoke associated with negative affect and nicotine dependence. Treatments targeting WM may be particularly useful for individuals with average to low WM who experience urge to smoke related to negative affect.

Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents.

Whether well-documented patterns of mental health comorbidity with adolescent combustible cigarette use extend to e-cigarette use is unclear. Demonstrating associations between e-cigarette and combustible cigarette use with mental health symptomatology across adolescence may be important for promoting accurate perceptions of populations at risk for and potential consequences of tobacco product use. Adolescents (N=2460; mean age at baseline=14.1; 53.4% female; 44.1% Hispanic) who had never previously used combustible or e-cigarettes were assessed at baseline, and 6- and 12-month follow-ups in Los Angeles, CA (2013-2014). Logistic regression was used to examine associations between baseline depressive symptoms and onset of e-cigarette and cigarette single product and dual use at follow-ups. Latent growth modeling was used to examine associations between sustained use of either product (vs. non-use) and changes in depressive symptoms over 12-months. Higher baseline depressive symptoms predicted subsequent onset of cigarette (OR=1.024, 95% C.I.=1.009-1.055), e-cigarette (OR=1.015, C.I.=1.003-1.023), and dual use of both products (OR=1.021, C.I.=1.003-1.043). Sustained use of e-cigarettes over the 12-month observation (vs. non-use) was associated with a greater rate of increase in depressive symptoms over time (b=1.272, SE=0.513, p=0.01). Among those who sustained use of e-cigarettes, higher frequency of use was associated with higher depressive symptoms at the final follow-up (B=1.611, p=0.04). A bi-directional association of depressive symptoms with e-cigarette use onset across mid adolescence was observed. Further research on the causal nature, etiological underpinnings, and intervention implications of mental health and tobacco product use comorbidity is warranted.

Influence of the A118G Polymorphism of the OPRM1 Gene and Exon 3 VNTR Polymorphism of the DRD4 Gene on Cigarette Craving After Alcohol Administration.

INTRODUCTION: The current study examined whether the presence of the G allele of the A118G polymorphism of the OPRM1 gene (rs1799971) and the long allele of exon 3 VNTR polymorphism of the DRD4 gene moderate the effect of alcohol administration on urge to smoke. These polymorphisms have been associated with greater alcohol induced-urge to drink. Urge to drink and alcohol consumption increase urge to smoke. Therefore, these polymorphisms may also sensitize urge to smoke after alcohol consumption. METHODS: Individuals smoking 10-30 cigarettes per day and reporting heavy drinking were recruited from the community. Caucasians (n = 62), 57.3% male, mean age 39.2, took part in a three-session, within-subjects, repeated-measures design study. Participants were administered a placebo, 0.4 g/kg, or 0.8 g/kg dose of alcohol. A118G genotype, exon 3 VNTR genotype, and urge to smoke (baseline and three times after receiving alcohol) were assessed. RESULTS: G allele carriers showed greater urge to smoke across all assessments. Additionally, a significant interaction indicated that G carriers, compared to homozygotes (AA), evinced a significantly greater increase in urge to smoke after high dose alcohol relative to placebo. The interaction between condition, DRD4 polymorphism, and time was not significant. CONCLUSIONS: Presence of G allele of the A118G polymorphism of the OPRM1 gene may lead to greater increases in urge to smoke after a high dose of alcohol. Pharmacotherapies targeted to opiate receptors (eg, naltrexone) may be especially helpful in aiding smoking cessation among G carriers who are heavy drinkers.

Effects of duration of electronic cigarette use.

INTRODUCTION: This study examined the effect of duration electronic cigarette (e-cigarette) use on e-cigarette dependence, frequency of use, and strength of nicotine solution as well as number of cigarettes smoked per day. METHODS: Individuals were recruited at e-cigarette retail locations in a large Midwestern metropolitan city of the United States in July 2013. A total of 159 participants completed a brief 29-item self-report measure that assessed behaviors and perceptions of use. The mean age of the participants was 35.8 years; 84.4% were White, and 53.7% were male. RESULTS: Increased duration of e-cigarette use was associated with fewer cigarettes smoked per day and differing patterns of dependence to e-cigarettes contingent upon smoking history. Additionally, increased duration of e-cigarette use was associated with increased frequency of use; however, this finding became nonsignificant when current tobacco cigarette use was accounted for, suggesting that individuals may increase e-cigarette use frequency as they decrease cigarette use. Overall, e-cigarette users tended to decrease the strength of nicotine in their e-cigarette products regardless of duration of use. CONCLUSIONS: Although preliminary in nature, this study identifies several factors that are important to consider when examining the effects of prolonged e-cigarette use. The implications of the current results should be informative to future studies that examine these variables in longitudinal designs.

Factor structure and validation of the Attentional Control Scale.

The Attentional Control Scale (ACS; Derryberry & Reed, 2002) has been used to assess executive control over attention in numerous studies, but no published data have examined the factor structure of the English version. The current studies addressed this need and tested the predictive and convergent validity of the ACS subscales. In Study 1, exploratory factor analysis yielded a two-factor model with Focusing and Shifting subscales. In Study 2, confirmatory factor analysis supported this model and suggested superior fit compared to the factor structure of the Icelandic version (Ólafsson et al., 2011). Study 3 examined correlations between the ACS subscales and measures of working memory, anxiety, and cognitive control. Study 4 examined correlations between the subscales and reaction times on a mixed-antisaccade task, revealing positive correlations for antisaccade performance and prosaccade latency with Focusing scores and between switch trial performance and Shifting scores. Additionally, the findings partially supported unique relationships between Focusing and trait anxiety and between Shifting and depression that have been noted in recent research. Although the results generally support the validity of the ACS, additional research using performance-based tasks is needed.

Dual tobacco use among college students: contexts of use, self-perceptions, and attitudes toward quitting.

Aggressive marketing of smokeless tobacco (SLT) appears to have led to an increase in dual tobacco use. The current study examines the situational contexts, self-perceptions, and cessation attitudes/behaviors that relate to dual use. Participants (N = 1,242) at a large, Southwestern university completed a self-report measure of demographic and tobacco use variables in 2010. Data were analyzed using chi-square and one-way ANOVA techniques. Findings suggest that type of tobacco use varies by setting and that dual users are more likely than sole users to perceive themselves as regular tobacco users. Limitations and implications for future research and interventions are discussed.

The influence of stress on the affective modulation of the startle response to nicotine cues.

Recent research suggesting that nicotine cues are appetitive in nature promotes the affective modulation of the startle reflex (AMSR) paradigm as a potentially valuable psychophysiological tool for elucidating mechanisms involved in nicotine addiction. Despite numerous studies indicating stress as a key factor in nicotine dependence, specific behavioral mechanisms linking stress and smoking have yet to be explicated. The current study aimed to determine the effects of stress, a negative affective state intimately linked with nicotine use, on the psychophysiological responding of nicotine dependent individuals during smoking cues. Twenty-nine nicotine dependent individuals were randomly assigned to the trier social stress test or control condition directly prior to administration of the AMSR paradigm, which examined their physiological responses to appetitive, neutral, aversive, and nicotine cue images. Both groups evinced significantly decreased startle magnitudes in response to nicotine cues as compared to aversive images. However, exposure to stress did not significantly modulate the startle reflex while viewing nicotine cues. Stress induction does not appear to modulate the AMSR paradigm when evaluating responses to nicotine images. These findings suggest that AMSR is robust to effects of acute stress induction in nicotine dependent individuals which may increase its viability as a clinical tool for assessing success in smoking cessation interventions.

Changes in smokeless tobacco use over four years following a campus-wide anti-tobacco intervention.

PURPOSE: This study examined the effectiveness of an institutional intervention aimed at decreasing prevalence of tobacco use over a 4-year period. METHODS: Participants were undergraduate students (N = 2,293) enrolled at a large Midwestern university between 2007 and 2010. In 2008, tobacco use was banned on campus. Additionally, campus-wide tobacco cessation services and information were provided to all students. A self-report measure assessing demographics and tobacco use prevalence was administered at baseline and at 3 timepoints over the following 3 years. RESULTS: Results indicated that smokeless tobacco use decreased significantly after the ban. Members of fraternities (a high-risk group) reported significant decreases in smokeless tobacco use for the first 2 years following the ban; however, this trend did not persist during the 3rd year of assessment. Off-campus residents displayed similar trends as fraternities. CONCLUSIONS: It appears that a campus-wide tobacco ban is an effective prevention method for decreasing smokeless tobacco use. However, initial decreases in smokeless tobacco use may not persist for some at risk groups, namely members of fraternities and students living off-campus. Future studies should examine prevalence of use over longer periods of time with a particular focus on at risk groups. Overall, this study lends considerable support for efforts toward tobacco-free campuses.

Working memory load moderates late attentional bias in social anxiety.

The vigilance-avoidance hypothesis suggests that socially anxious individuals attempt to detect signs that they are being evaluated (vigilance) and subsequently direct attention away from such stimuli (avoidance). Although extensive evidence supports vigilance, data concerning subsequent avoidance is equivocal. Drawing from models of attention, the current study hypothesised that working memory load moderates late attentional bias in social anxiety such that avoidance occurs if working memory load is low, and difficulty disengaging attention occurs if working memory load is high. Forty-one undergraduates (19 socially anxious; 22 non-anxious controls) completed a dot-probe task with emotional (happy and disgust) and neutral facial expressions and a concurrent n-back task. Results supported the hypothesis such that socially anxious subjects demonstrated avoidance of disgust faces when working memory load was absent, but had difficulty disengaging attention during high working memory load. Theoretical implications and directions for future research are discussed.

Adolescent and Young Adult Response to Hypothetical E-Liquid Flavor Restrictions.

OBJECTIVE: Rates of e-cigarette use among adolescents and young adults (AYAs) remain high despite several federal policy changes intended to limit their availability and appeal. The current study examined how restricting flavors would affect current AYA users' intentions to discontinue vaping, as a function of their current flavor preference. METHOD: In a national cross-sectional survey, AYA e-cigarette users (N = 1,414) completed measures of e-cigarette use, device type, e-liquid flavor (tobacco, menthol, cool mint, fruit ice, fruit/sweet), and intent to discontinue e-cigarette use in response to hypothetical federal product standards (i.e., tobacco and menthol or tobacco-only e-liquid). Logistic regression was used to model the association of preferred flavor with odds of discontinuing e-cigarette use (vs. continuing), for menthol and tobacco hypothetical product standards. RESULTS: Overall, 38.8% of the sample reported intent to discontinue using their e-cigarette if tobacco and menthol-flavored e-liquid were the only options available, whereas 70.8% would discontinue under a tobacco-only product standard. AYAs preferring fruit/sweet flavor were most sensitive to either restricted scenario, with odds of discontinuing use ranging from adjusted odds ratio (aOR) = 2.22 to aOR = 2.38 under a tobacco and menthol product standard and aOR = 1.33 to aOR = 2.59 under a tobacco-only product standard, compared with other flavor preferences. In addition, AYAs using cooling flavors (e.g., fruit ice) reported higher odds of discontinuing use under a tobacco-only product standard, compared with menthol flavor users, indicating an important distinction between these groups. CONCLUSIONS: Results indicate potential for flavor restrictions to reduce use of e-cigarettes among AYAs and suggest that a tobacco flavor product standard may result in the greatest discontinuation of use.

Associations Between Internalizing and Externalizing Symptoms on Subsequent Tobacco Product Initiation and Sustained Use as a Function of Sex Among Adolescents Ages 12-17.

OBJECTIVE: Previous studies have found positive associations between internalizing and externalizing symptoms and the initiation of tobacco use among adolescents. However, few studies have examined the relationship between these symptoms and sustained tobacco use patterns or how they may vary as a function of sex. The current study examined whether these symptoms predict initiation and sustained use of multiple tobacco products within a longitudinal cohort design. METHOD: Waves 1-3 of the Population Assessment of Tobacco and Health Study (2013-2016) were used to assess relationships between internalizing and externalizing symptoms, sex, and tobacco use categories (cigarettes, e-cigarettes, poly-tobacco use, other tobacco use) in 6,170 adolescents (M age = 13.42, SD = 1.10) who were tobacco naive at Wave 1. RESULTS: Internalizing and externalizing symptoms predicted initiation of several tobacco categories at the 2-year follow-up. Examining sustained use patterns revealed a more consistent relationship with externalizing symptoms across tobacco categories, whereas associations with internalizing symptoms were limited. Sex moderated the relationship between elevated internalizing symptoms and increased odds of subsequent e-cigarette and poly-tobacco initiation, with stronger relationships observed among females. In addition, the relationship between elevated externalizing symptoms and sustained other tobacco use was stronger in females as compared with males. CONCLUSIONS: Although both internalizing and externalizing symptoms predict tobacco initiation across several product categories, externalizing symptoms may reflect a more reliable signal of sustained tobacco use in adolescents. Mental health symptoms and subsequent tobacco use differed by sex, with females demonstrating stronger relationships for several products.

Assessment of psychological distress as a function of positive psychological variables during the COVID-19 pandemic: A university longitudinal study.

Objective: To examine changes in psychological distress of college students as a function of demographic and psychological variables over time during the COVID-19 pandemic. Participants: Subjects were recruited from a large public university in Northeast Ohio using electronic surveys administered at three time points in 2020. Methods: Demographics, positive psychological metrics (flourishing, perceived social support, and resilience) and psychological distress were collected and a mixed linear model was run to estimate their effect on change in distress. Results: Psychological distress did not change significantly across time. Females experienced more psychological distress than males. Higher levels of flourishing, perceived social support, and resilience were associated with less distress overall. Conclusions: Although psychological distress did not change across observed time, previous data suggests heightened psychological distress that remained elevated across observed time during the COVID-19 pandemic. Positive psychological variables were shown to mitigate psychological distress, and the relationship was stable over time.

Tobacco Use Status as a Function of Transgender Identity: The Mediating Role of Psychological Distress.

AIM: The current study examined differences between individuals identifying as transgender and people identifying as cisgender in terms of (1) psychological distress (eg, anxiety, depression, and suicidal ideation), (2) rates of combustible and e-cigarette use, and (3) the potential for elevated psychological distress stemming from transgender identification to be associated with increased rates of smoking and vaping. METHOD: This was a secondary analysis of data from a study examining behavioral health, perceptions and behaviors associated with alcohol and other drug use, and mental health status at a large mid-western university. Differences in current use of cigarette and e-cigarette products were examined between self-identified transgender (n = 253) and cisgender (n = 18 371) respondents. RESULTS: Overall, 17.2% (n = 2727) of the sample endorsed past 30-day use of cigarettes or e-cigarettes. Results demonstrated a significant effect of gender identity, with individuals identifying as transgender reporting higher odds of using cigarettes or e-cigarettes (AOR = 2.82, 95% CI 1.26-6.31). Regression analyses revealed significant effects of transgender identity on symptoms of anxiety (b = 3.45, 95% CI = 1.64, 5.25, P < .001.); depression, (b = 4.14, 95% CI = 2.21, 6.07, P < .001); and suicidal ideation, (b = 2.51, 95% CI = 1.48, 3.55, P < .001.), respectively. Finally, we observed significant indirect effects of transgender identity on cigarette and e-cigarette product use via increased symptoms of depression (indirect effect = 0.13, 95% CI [0.07, 0.19], P < .05), and suicidal ideation (indirect effect = 0.22, 95% CI [0.15, 0.28], P < .05), but not symptoms of anxiety. DISCUSSION: This is the first study of our knowledge to examine the association between psychological symptoms and smoking and vaping products with transgender identity. The results of this study support previous findings that transgender individuals are at risk for elevated substance use and extend the literature by demonstrating this this risk is associated with elevated psychological distress.

Youth use of e-cigarettes: Does dependence vary by device type?

INTRODUCTION: Youth nicotine dependence may vary by e-cigarette device used. METHODS: E-cigarette device type ("JUUL," "similar pod/JUUL like device (i.e., pod mod)," or "other type of e-cigarette" (i.e., tank, mod)), nicotine dependence (Hooked on Nicotine Checklist; HONC), frequency of e-cigarette use (i.e., weekly, daily, monthly), and covariates were examined via a convenience sample of youth who use e-cigarettes in the United States via an online Qualtrics panel survey from April 2019 to May 2019. RESULTS: Youth aged 13-17 (Mean age = 15.9 years, SD = 1.0 year; n = 185) were mostly 72.4% female. Primary device used by category was endorsed as follows: JUUL n = 87, pod mod n = 42, and other type of e-cigarette n = 56. Participants endorsed an average of 4.5 / 10 HONC symptoms (SD = 3.6). Compared to other e-cigarettes, youth who used JUUL and pod mod devices endorsed more dependence symptoms, even when adjusting for current smoking status (JUUL IRR = 1.96, 95% CI 1.30-2.97; pod mod device IRR = 1.76, 95% CI 1.08-2.87). In total, HONC symptoms significantly differed by device for 8/10 symptoms, with JUUL and pod mod users reporting higher frequency of items compared to other e-cigarette devices. CONCLUSIONS: Features of nicotine dependence experienced by youth (i.e., feeling a stronger urge to vape) differed by primary device used, with those using JUUL and pod-mods reporting a greater level of dependence. Regulation of features of e-cigarette devices that may increase nicotine delivery and subsequent development of dependence among youth warrant urgent consideration.

Harm Perceptions of Tobacco/Nicotine Products and Child Exposure: Differences between Non-Users, Cigarette-Exclusive, and Electronic Cigarette-Exclusive Users.

OBJECTIVE: This study examined caregiver perception of harm and child secondhand exposure to nicotine in a sample of e-cigarette-exclusive, cigarette-exclusive, and non-tobacco/nicotine users (non-users). METHODS: Cigarette-exclusive (n = 19), e-cigarette-exclusive (n = 12), and non-users (n = 20) and their children (N = 51, Mage = 10.47) completed self-report questionnaires about perceptions of harm, child secondhand exposure, and provided urine to assess child nicotine exposure (cotinine). ANOVAs examined differences between caregiver use status on tobacco harm perceptions and child cotinine levels. Independent samples t-test compared differences in caregiver-reported child secondhand exposure in the home and car. RESULTS: All 3 caregiver groups rated cigarettes as highly harmful (P = .14), but e-cigarette users rated all 3 types of e-cigarette products (Cartridge-based: P < .001; Tank: P < .001; Box Mod: P < .001) as less harmful than cigarette users and non-users. Caregivers from the e-cigarette user group reported greater child secondhand exposure than caregivers using cigarettes (past 7-day in-home exposure (P = .03); past 7-day exposure in-home + in-car exposure (P = .02); in-home exposure by caregivers and other people exposure (P = .02)). Children from the cigarette user group had significantly higher levels of cotinine (M = 16.6, SD = 21.7) compared to children from the Non-User group (M = .43, SD = .95; P = .001), but no significant difference when compared to children from the E-Cigarette User group (M = 6.5, SD = 13.5). DISCUSSION: In this sample, caregivers who used e-cigarettes perceived them as less harmful, reported using them more frequently at home and in the car, even when their children were present, compared to cigarette users. As a result, children appear to be exposed to nicotine at levels similar to children living with cigarette users. Future caregiver prevention and intervention efforts should target education around the potential harms of secondhand e-cigarette aerosol to children.

Changes in alcohol use as a function of psychological distress and social support following COVID-19 related University closings.

Amidst the coronavirus pandemic, universities across the country abruptly closed campuses and transitioned to remote learning. The effects of these unprecedented closures are unknown. The current study examined reported alcohol consumption during the week prior to and after campus closure at a public university in Northeast Ohio. Analysis of data from 1,958 students, who endorsed using alcohol in the past 30 days, demonstrates that alcohol consumption (amount and frequency) increased as time progressed. Those with more symptoms of depression and anxiety reported greater increases in alcohol consumption (assessed via retrospective timeline follow-back) compared to students with fewer symptoms. Furthermore, students with greater perceived social support reported less alcohol consumption. Together, these findings highlight the need for universities to offer services and programs to students that will minimize risk factors and maximize protective factors in order to reduce or prevent alcohol abuse during the coronavirus pandemic.