Association between free tobacco product sample receipt and tobacco use in youth and adults in the PATH Study, 2014-2016.

Tobacco companies have distributed free samples of tobacco products in the past. While prior studies have found a relationship between various marketing strategies and tobacco use, no study has assessed the prevalence of free sample receipt or the relationship between receipt and subsequent tobacco use. We analyze three waves of Population Assessment of Tobacco and Health (PATH) Study data to provide the first nationally representative prevalence estimates of free tobacco product receipt among US youth and adults in 2014 to 2016. This analysis also examines the relationship between free tobacco product receipt and ever, past 30-day, and new tobacco use one year later. The prevalence of free sample receipt in the US population in 2014-2016 was 0.8% for any tobacco product but 1.6% for ENDS/e-liquid in adults, and 0.5% for any tobacco product but 1.05% for ENDS/e-liquid in youth. Free sample receipt was higher among vulnerable subgroups. Receipt of free tobacco product samples was associated with tobacco use status using cross-sectional data in youth and adults, as well as one year later in youth. Receipt of a free ENDS or e-liquid sample was associated with any tobacco and ENDS use status using cross-sectional data in youth and adults. After these data were collected, the US Food and Drug Administration broadened the ban on distributing free samples to include all tobacco products except smokeless tobacco in adult-only facilities. Our findings support limiting free samples to further prevent youth access to tobacco products.

Youth Access to Tobacco Products in the United States: Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study.

OBJECTIVES: Tobacco products in the US market are growing in diversity. Little is known about how youth access tobacco products given this current landscape. METHODS: Data were drawn from 15- to 17-year-olds from the Wave 1 youth sample of the US nationally representative Population Assessment of Tobacco and Health (PATH) Study. Past 30-day tobacco users were asked about usual sources of access to 12 different tobacco products, and if they had been refused sale because of their age. RESULTS: Among 15- to 17-year-olds, social sources ("someone offered" or "asked someone") were the predominant usual source of access for each tobacco product. "Bought by self" was the usual source of access for users of smokeless (excluding snus, 23.2%), cigarillos (21.0%), cigarettes (13.8%), hookah (12.0%), and electronic cigarettes (10.5%). Convenience stores and/or gas stations were the most often selected retail source for all products except hookah. Among youth who attempted purchase, 24.3% were refused sale of cigarettes, 23.9% cigarillos, and 13.8% smokeless tobacco. CONCLUSIONS: Most 15- to 17-year-old tobacco users obtain tobacco products through social sources; however, among those who purchased tobacco, the majority report not being refused sale because of age. At the time of survey, cigarette and cigar sales to under 18 years were prohibited in all 50 states, and electronic cigarettes sales in 47 states and two territories. 2014 Annual Synar Reports signaled increasing trends in retail violations of state and/or district laws prohibiting tobacco product sales to under 18 years. Monitoring illicit youth sales, conducting compliance check inspections, and penalizing violations remain important to reduce youth tobacco access at retail venues. IMPLICATIONS: Access to the spectrum of tobacco products by youth in the United States remains predominantly through social sources. However, of the minority of youth tobacco users in 2014 who purchased tobacco themselves, a few reported being refused sale: Convenience stores and/or gas stations were the most common retail source for tobacco products. The strategies of monitoring illicit youth sales, conducting compliance checks, and penalizing violations remain important to reduce youth tobacco access at retail venues. Limiting sources of youth tobacco access remains an important focus to reduce the burden of tobacco on the public health.

Curiosity About and Susceptibility Toward Hookah Smoking Among Middle and High School Students.

INTRODUCTION: Hookah smoking has increased among young people. Curiosity and susceptibility may be associated with experimentation or established use. Because tobacco use behaviors are established primarily during adolescence, our objective was to examine factors that may increase the risk of future tobacco product use among youth. METHODS: We analyzed data from the 2016 National Youth Tobacco Survey, a nationally representative survey of US students. Analyses were restricted to youth who had never smoked a hookah and stratified by their ever having used other tobacco products. The prevalence of hookah curiosity and susceptibility was assessed by sociodemographic characteristics, perceptions of harmfulness and addictiveness of hookahs, and peer use of hookahs. Associations between covariates and curiosity and susceptibility were assessed by using multivariable-adjusted regression. RESULTS: Overall, 29.1% of students reported any hookah curiosity or susceptibility. Curiosity was reported by 14.6% of those who never used tobacco products and by 45.9% of those who ever used tobacco products. Hookah susceptibility was reported by 15.6% of never-users and 52.5% of ever-users. Regardless of ever having used other tobacco products, odds of curiosity and susceptibility were higher among students with perceptions of reduced hookah harmfulness and addictiveness and among those who perceived high levels of hookah use among peers. CONCLUSION: Nearly 3 in 10 youth who never smoked a hookah (6.9 million) reported hookah curiosity or susceptibility, and prevalence was highest among those who had ever used other tobacco products. These findings reinforce the importance of educating youth about the dangers of all tobacco products and dispel misperceptions about the harmfulness and addictiveness of hookah smoking. Continued surveillance of youth curiosity, susceptibility, and use of hookahs can inform public health policy and practice.

E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students.

Understanding factors associated with youth e-cigarette openness and curiosity are important for assessing probability of future use. We examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey (NYTS) were analyzed. The 2015 NYTS is a nationally representative survey of 17,711 U.S. middle and high school students. We calculated weighted prevalence estimates of never users of tobacco products (cigarettes, cigars/cigarillos/little cigars, waterpipe/hookah, smokeless tobacco, bidis, pipes, dissolvables, e-cigarettes) who were open to or curious about e-cigarette use, by demographics. Weighted regression models examined how e-cigarette harm perceptions and advertising exposure were associated with openness using e-cigarettes and curiosity about trying e-cigarettes. Among respondents who never used tobacco products, 23.8% were open to using e-cigarettes and 25.4% were curious. Respondents that perceived e-cigarettes cause a lot of harm had lower odds of both openness (OR = 0.10, 95% CI = 0.07, 0.15) and curiosity about e-cigarettes (OR = 0.10, 95% CI = 0.07, 0.13) compared to those with lower harm perception. Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use (OR = 1.22, 95% CI = 1.03, 1.44) and highly curious (OR = 1.25, 95% CI = 1.01, 1.53) compared to those not highly exposed. These findings demonstrate that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace.

Characteristics of Hookah Tobacco Smoking Sessions and Correlates of Use Frequency Among US Adults: Findings From Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study.

Introduction: Hookah tobacco smoking has increased in the United States. However, information on hookah use frequency and other characteristics of hookah use is limited. Methods: Investigators analyzed data from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US youth and adults. Our analysis draws on baseline data from adult (ages ≥18 years) ever (N = 10 624) and past year (n = 3947) hookah users. Bivariate and regression analyses were conducted to identify associations between demographics, use characteristics, and hookah use frequency. Results: Overall, 16.4% of adults reported ever smoking tobacco from a hookah. Of those, 31.9% reported smoking hookah within the past year. Among 3947 past-year hookah tobacco smokers, 10.7% were daily/weekly users, 13.7% were monthly users, 42.1% smoked every couple of months, and 33.5% smoked about once a year. Among daily/weekly hookah users, 66% were young adults (ages 18-24 years). When comparing daily/weekly hookah users to those who smoked every couple of months, more frequent hookah use was associated with younger age, male gender, a greater number of times the hookah is refilled during a session, fewer people sharing, and hookah ownership. Conclusion: Although there were few demographic differences between daily/weekly users and less frequent hookah tobacco smokers, some notable differences in use behaviors exist among use frequency groups. Unlike other tobacco products, hookah is often smoked communally, over an extended time period. A detailed understanding of hookah user characteristics and experiences could inform hookah-specific measures, messaging, and regulations. Implications: To our knowledge, this is one of the first studies to characterize hookah use frequency, session length, and other hookah use experiences using a nationally representative sample of US adult hookah smokers. Understanding characteristics of hookah tobacco smokers, their use experiences, and patterns of hookah use frequency would be useful in assessing risks for hookah tobacco dependence at the population level. Additionally, identifying variation in use behaviors of hookah tobacco smokers could be used to inform the development of strategies to reduce and prevent hookah tobacco use, such as tobacco regulations or public education efforts, particularly among young adults.

Racial and Ethnic Differences in Tobacco Information Seeking and Information Sources: Findings From the 2015 Health Information National Trends Survey.

This article describes sources of health information, types of tobacco information sought, and trust in sources of tobacco information among U.S. racial/ethnic groups (Whites, Blacks, Hispanics, Asian and Pacific Islanders, and Other). Cross-sectional data (N = 3,788) from a nationally representative survey, HINTS-FDA 2015, were analyzed to examine unadjusted and adjusted associations between race/ethnicity and (a) first source of health information, (b) tobacco information seeking, and (c) trust in sources of tobacco information. Adjusted associations controlled for current tobacco product use and sociodemographic variables. Findings indicated that the Internet was the most common first source of health information while health care providers were the second most common source for all racial/ethnic groups. Tobacco-related health information seeking was more prevalent than other tobacco product information seeking. Unadjusted analyses indicated that a higher proportion of Whites sought other tobacco product information compared to Asians and Pacific Islanders. Trust was rated highest for doctors while trust for health organizations was rated second highest. Asians and Pacific Islanders had higher trust in the government compared to all other groups. Blacks had higher trust in religious organizations compared to all other groups besides Hispanics. Blacks had higher trust for tobacco companies compared to Whites and Other. Many of these differences were attenuated in adjusted analyses. This research has implications for tobacco control practice and policymaking by identifying potential dissemination strategies.

Frequency of Workplace Controls and Associations With Safety Perceptions Among a National Sample of US Food Retail Workers During the COVID-19 Pandemic.

OBJECTIVES: Explore workplace control frequencies and factors associated with US food retail workers' safety perceptions during COVID-19. METHODS: An online, cross-sectional survey captured working conditions and safety perceptions among a large, national sample of US food retail workers from July to October 2020. RESULTS: Overall, 40.3% reported feeling "not so" or "not protected" by COVID-19 controls. Administrative controls were more commonly reported (56.8% reported ≥5 controls) than engineering (19.5% reported ≥3). Fomite-related controls were more common than those reducing interpersonal contact. After adjustment, organizational safety climate (prevalence ratio (PR): 1.53, 95% CI: 1.24, 1.89), and perceived strict prevention measure enforcement (PR: 0.60, 95% CI: 0.46, 0.78) were associated with safety perceptions. CONCLUSIONS: Many workers do not feel well-protected by COVID-19 controls. Safety climate and control enforcement are associated with workers' COVID-19 safety perceptions.

Transitions in frequency of hookah smoking among youth and adults: findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study, 2013-15.

BACKGROUND AND AIMS: The prevalence of hookah smoking has increased in the United States since at least 2010, especially among youth and young adults. This study assessed self-reported reasons for hookah smoking cessation and transition to or maintenance of high-frequency hookah smoking among current hookah smokers. DESIGN: Separately analyzed data from the Population Assessment of Tobacco and Health (PATH) study, a longitudinal cohort study. Frequency of and reasons for hookah smoking were ascertained at wave 1 (2013-14); frequency of hookah smoking and past-year cessation were ascertained at wave 2 (2014-15). Weighted multivariable logistic and ordinal logistic regression models were fitted to predict hookah smoking cessation and frequency of hookah smoking at wave 2, respectively, accounting for demographic and behavioral risk factors, reasons for hookah smoking and frequency of hookah smoking at wave 1. SETTING: United States. PARTICIPANTS: A total of 693 youth and 4400 adult past-year hookah smokers. MEASUREMENTS: Self-reported tobacco-use patterns and associated health behaviors were measured via audio computer-assisted self-interviews (ACASI). FINDINGS: At wave 1, 5.9% of youth and 7.5% of adults were past-year hookah smokers. Among all age groups, the leading reasons for hookah smoking were enjoyment of socializing while smoking, the availability of appealing flavors and believing that it was less harmful than cigarette smoking. The odds of cessation were lower for adults who liked hookah flavors [adjusted odds ratio (aOR) = 0.40; 95% confidence interval (CI) = 0.26-0.62] compared with adults who did not like hookah flavors. The odds of transitioning to, or maintaining, monthly or more frequent hookah smoking at wave 2, compared with cessation or less than monthly smoking, were higher for adults who liked hookah flavors [adjusted proportional odds ratio (aPOR) = 2.10; 95% CI = 1.48-2.99 and enjoyed socializing while smoking hookah (aPOR = 1.82; 95% CI =1.13-2.94) compared with adults who did not like hookah flavors or socializing. CONCLUSION: The availability of appealing flavors, affordability and socialization while smoking hookah in the United States are associated with reduced likelihood of cessation and increased likelihood of high-frequency hookah smoking.