Racial/ethnic disparities in exposure to e-cigarette advertising among U.S. youth.

OBJECTIVES: This study aims to assess exposure to e-cigarette advertising across multiple marketing channels among U.S. youth and to examine whether racial/ethnic disparities exist in exposure to e-cigarette advertisements. STUDY DESIGN: This is a cross-sectional study. METHODS: Cross-sectional data were drawn from a longitudinal survey of participants recruited from two nationally representative panels (NORC's AmeriSpeak® and GfK's KnowledgePanel). A total of 2043 youth aged 13-17 completed the initial 2018 survey, and 2013 youth completed the follow-up survey in 2019 (including a replenishment sample of 690 youth). Outcome variables were self-reported e-cigarette advertisement exposure in the past three months through various sources, such as television, point of sale, and online/social media. Generalized estimating equation models were used to estimate the adjusted odds ratios (AOR) of the association between racial/ethnic identity and e-cigarette advertisement exposure. RESULTS: The prevalence of reported exposure to e-cigarette advertisements through any channel was 79.8% (95% CI: 77.1-82.2) in 2018 and 74.9% (95% CI: 72.5-77.1) in 2019, respectively. Point of sale was the most common source of e-cigarette advertisement exposure in both years. Non-Hispanic Black and non-Hispanic Asian youth were more likely to report exposure to e-cigarette advertisements through television (AOR = 2.07, 95% CI: 1.44-2.99 and AOR = 2.11, 95% CI: 1.17-3.82, respectively) and online/social media (AOR = 1.61; 95% CI: 1.11-2.33 and AOR = 1.99, 95% CI: 1.10-3.59, respectively) channels compared with non-Hispanic White youth. CONCLUSIONS: A substantial proportion of U.S. youth reported exposure to e-cigarette advertising through a variety of marketing channels. Significant racial/ethnic disparities existed, with non-Hispanic Black and Asian youth reporting more marketing exposure than their non-Hispanic White counterparts.

Flavored e-cigarette use: Characterizing youth, young adult, and adult users.

The purpose of this study is to investigate how the use of flavored e-cigarettes varies between youth (12-17 years old), young adults (18-29 years old), and older adults (30 + years old). Cross-sectional surveys of school-going youth (n = 3907) and young adult college students (n = 5482) in Texas, and young adults and older adults (n = 6051) nationwide were administered in 2014-2015. Proportions and 95% confidence intervals were used to describe the percentage of e-cigarette use at initiation and in the past 30 days that was flavored, among current e-cigarette users. Chi-square tests were applied to examine differences by combustible tobacco product use and demographic factors. Most e-cigarette users said their first and "usual" e-cigarettes were flavored. At initiation, the majority of Texas school-going youth (98%), Texas young adult college students (95%), and young adults (71.2%) nationwide said their first e-cigarettes were flavored to taste like something other than tobacco, compared to 44.1% of older adults nationwide. Fruit and candy flavors predominated for all groups; and, for youth, flavors were an especially salient reason to use e-cigarettes. Among adults, the use of tobacco flavor at initiation was common among dual users (e-cigarettes + combustible tobacco), while other flavors were more common among former cigarette smokers (P = 0.03). Restricting the range of e-cigarette flavors (e.g., eliminating sweet flavors, like fruit and candy) may benefit youth and young adult prevention efforts. However, it is unclear what impact this change would have on adult smoking cessation.

Smoking-attributable cancer mortality in 1991: is lung cancer now the leading cause of death among smokers in the United States?

Findings from the new American Cancer Society prospective study of 1.2 million men and women indicate that mortality risks among smokers have increased substantially for most of the eight major cancer sites causally associated with cigarette smoking. Lung cancer risk for male smokers doubled, while the risk for females increased more than fourfold. On the basis of the new American Cancer Society relative risks, we project that cigarette smoking alone will contribute to slightly more than 157,000 of the 514,000 total cancer deaths expected to occur in the United States in 1991. Overall, smoking directly contributes to 21.5% of all cancer deaths in women but 45% of all cancer deaths in men. It would also appear that lung cancer has now displaced coronary heart disease as the single leading cause of excess mortality among smokers in the United States.

Prevalence of tobacco dependence and withdrawal.

In a sample of 1,006 middle-aged male smokers drawn from the general population, 90% (N = 905) fulfilled DSM-III criteria and 36% (N = 362) fulfilled Fagerstrom's criteria for tobacco dependence. Among the 875 who had stopped smoking in the past for at least 24 hours, 21% (N = 184) fulfilled DSM-III criteria and 46% (N = 403) fulfilled the authors' own criteria for tobacco withdrawal. Concordance of results among the criteria for diagnosing tobacco dependence and withdrawal was low. These results suggest that the DSM-III criteria for tobacco dependence are overinclusive and that there is little consensus among the definitions of tobacco dependence and withdrawal.

New Roads: assessing and treating psychological dependence.

The "New Roads" approach provides a practical tool for explaining and assessing dimensions of psychological dependence. It connects common triggers for relapse and the effects that the client intends to achieve through substance use. Among its clinical applications are (a) preventive education, (b) assessing high risk situations, (c) tracing pathways of psychological dependence, and (d) devising alternative coping strategies. This simple technique is compatible with a wide range of treatment settings, goals, and approaches.

Relation of puff volume to other topographical measures of smoking.

Puff volume, puff duration, interpuff interval, cigarette interval, puffing rate, and number of puffs per cigarette were recorded in eight normally smoking subjects during five daily one-hour laboratory sessions. Topographical measures showed wide variability across subjects, but measures were relatively stable within subjects. Puff volume was significantly positively correlated with puff duration for five subjects. As the cigarette was smoked, puff duration remained relatively constant, while puff volume decreased systematically and interpuff interval increased initially and then decreased.

A comparison of self-help approaches to smoking cessation.

The current study evaluated the effectiveness of widely used self-help materials for quitting smoking. Five hundred and seventy smokers volunteered during a baseline survey to participate in the evaluation. After random assignment, 200 were mailed National Cancer Institute (NCI) "Quit for Good" materials, 200 the Minnesota "Quit and Win" program, and the remaining 170 were assigned to a nonintervention control condition. Results at 7-month follow-up failed to indicate treatment effects either for abstinence or for reported quit attempts. A number of smokers quit prior to the mailing of self-help materials, suggesting that a telephone prompt in itself may have been an important stimulus to cessation. Overall abstinence at follow-up was 10%. Contrary to expectation, successful participants were less likely to use a number of specific preparation strategies for quitting. The results are instructive in providing a large-scale assessment of self-help materials in a population of smokers that was not specifically seeking treatment.

Incorporating social support into a community-wide smoking-cessation contest.

Social support for smoking cessation has been identified as a key factor differentiating which individuals are most likely to quit smoking. Attempts to enhance social support in clinic-based programs have generally been unsuccessful. This study investigated a strategy for increasing the involvement of supportive others among participants in a community-based smoking-cessation contest. These smokers were undertaking quit attempts without the supportive environment offered in clinic-based group programs. Subjects included 734 adult smokers who had participated in a smoking-cessation contest in their local community. Contest participants had the option of designating a "support person" who would assist them in quitting smoking and be eligible for prizes if the participant was a contest winner. Follow-up was by telephone survey 3 months after the end of the contest. No differences were observed in demographic or smoking history variables between those who did and did not elect to name a support person. A relatively high proportion (60%) of contest participants elected to identify a support person and self-reported smoking-cessation rates were significantly better among those who named a support person than among those who did not. Identifying a support person was a particularly effective strategy for those with smoking or nonsupportive spouses.

Differences in smoking cessation strategies between men and women.

This descriptive research was designed to identify differences in smoking cessation strategies between men and women in a cross-sectional population sample of current smokers in the upper Midwest. Data on the number of previous quit attempts, the success and persistence in quit attempts, future intentions to change smoking habits, and strategies planned for cessation were obtained from 1669 smokers. Log-linear analyses controlling for age and the number of cigarettes smoked revealed significant gender differences. Men and women appear to approach smoking cessation differently. Women were more tentative and less committed to quitting smoking entirely. Women were also less successful in sustaining smoking cessation attempts for longer than one week. Efficacy expectations and differential attributions for failure were suggested as possible explanations for the results, however further research will be necessary to confirm or disconfirm these hypotheses.

A probabilistic model of intensive designs.

Without internal validity, experimental data are uninterpretable. With intensive designs, most methods presented to quantify a design's internal validity have been subject to criticism. A probabilistic model of intensive designs is presented that demonstrates the high degree of internal validity of these designs without relying on adaptations from traditional inferential statistics. Where the experimenter is able to conform to the restrictions of the model, the equations provide an estimation of internal validity for either reversal or multiple-baseline designs. More importantly, the model provides mathematical bases for some of the common recommendations and design considerations in intensive research (such as the desirability of within-subject replications and of four or more multiple baselines).

Attitudes toward smoking cessation among men and women.

Recent reports indicate that women are less successful than men in their attempts to quit smoking. Sex differences in attitudes toward smoking cessation were examined cross-sectionally in a sample of 447 smokers randomly selected from employees of 10 diverse Minnesota worksites and interviewed in early 1984. No sex differences were found in the percentage of smokers who had tried to quit at least once in the past; indeed, over four of five respondents reported prior attempts to quit. Yet compared to women, men were more interested in quitting. Women were less likely than men to perceive the health benefits of quitting and expressed more concern about weight gain and job pressures related to quitting. No significant sex differences were found in prior use of formal cessation services, which had been used by about one-fourth of these respondents. Yet compared to men, women appeared to rely on informal sources of support, such as encouragement from co-workers. These findings underline the importance of intervention programs targeting women and suggest strategies that might enhance the effectiveness of such programs oriented toward women.

Implementing nonsmoking policies in the private sector and assessing their effects.

Nonsmoking policies are being implemented increasingly in worksites across the country. This cross-sectional study examined attitudes toward worksite nonsmoking policies and worksite norms about smoking and cessation. Data were collected by telephone interview from 711 smokers and recent ex-smokers employed in seven worksites in Bloomington, Minnesota, in 1986. The findings indicated widespread support for nonsmoking policies even among smokers. Support for nonsmoking policies was especially high among respondents interested in quitting smoking, those concerned about the health effects of smoking, those reporting high coworker support for prior cessation attempts, and those working with a high proportion of nonsmokers. Support for nonsmoking policies was also correlated with smoking cessation in the 18 months prior to the survey. The clustering of these social norms is indicative of a worksite "culture" that may either support nonsmoking or inhibit cessation.

Promoting smoking cessation at the workplace. Results of a randomized controlled intervention study.

This paper presents results from a preliminary short-term work-site intervention study aimed at smoking cessation. The 3-month intervention included consultation for employers on the adoption of a nonsmoking policy, training for nonsmokers to provide assistance to smokers attempting to quit, and cessation classes for smokers. Eight work sites from Bloomington, Minnesota were recruited to the study and randomly assigned to an intervention or comparison condition after a baseline survey of all employees. To assess the effect of the intervention, smokers were surveyed 1 and 6 months after the intervention was completed. At the 1-month follow-up, the overall quit rate in the intervention group was 12% compared to 5% in the control group (P < .05). At the 6-month follow-up, 12% of smokers in the intervention group reported quitting, compared to 9% in the control group (P < .05). Co-worker support for quitting was higher in the intervention group compared to the comparison group. Cessation was highest overall among smokers whose co-workers frequently asked them not to smoke and among those who worked with a high proportion of nonsmokers. These results indicate that a short-term, multifaceted smoking cessation program implemented in work sites can affect smoking cessation rates as well as the work-site norms about smoking.