Teens Less Susceptible to Vaping When Restricted to Tobacco-Flavored E-cigarettes: Implications for Flavored Tobacco Policies.

INTRODUCTION: Flavors added to tobacco products increase their appeal to youth and contribute to the youth vaping epidemic. To address this problem, over 340 localities have implemented various policies to restrict access to flavored tobacco products. Few studies have examined the extent to which restricting available e-cigarette flavors might affect e-cigarette initiation or cessation among youth. AIMS AND METHODS: A representative sample of Minnesota teens were asked about their use of e-cigarettes, symptoms of e-cigarette dependence and their willingness to use an e-cigarette under four flavor conditions: unspecified (any flavor); menthol, tobacco, or unflavored. Respondents with data on all four flavor conditions were included in the analysis (N = 2151). RESULTS: Cochran's Q, McNemar, and exact binomial tests revealed that susceptibility to e-cigarette use was highest when the flavor was unspecified (38.2%), lower for unflavored (29.7%) and menthol-flavored e-cigarettes (26.7%), and lowest when the flavor was tobacco (21.0%). Among the subsets of students who had never tried e-cigarettes and students who reported signs of e-cigarette dependence, the largest decrease in susceptibility from unspecified flavor e-cigarettes was observed for tobacco-flavor, a decrease of 12.7 and 19.6 percentage points, respectively. CONCLUSIONS: Whether teens had no experience using e-cigarettes or showed signs of dependence, the percentage of teens who were susceptible to using e-cigarettes was significantly lower when the flavor available was restricted. Susceptibility was lower for tobacco- and menthol-flavored than unflavored e-cigarettes, suggesting that teens consider these flavors aversive. IMPLICATIONS: These results suggest that policies that eliminate all e-cigarette flavors except tobacco may be a powerful tool for advancing youth e-cigarette prevention and cessation goals by reducing the appeal of e-cigarettes to teens with different levels of experience with them, including teens who have never tried e-cigarettes and those who may find it difficult to quit using them.

Local Tobacco 21 Policies are Associated With Lower Odds of Tobacco Use Among Adolescents.

INTRODUCTION: Tobacco 21 (T21) policies have shown promise in reducing cigarette use among adolescents. This study examined whether local T21 policies affected adolescent use of a variety of tobacco products and whether results differed by grade level. METHODS: We used repeated cross-sectional data from eighth, ninth, and eleventh-grade respondents to the 2016 (n = 107 981) and 2019 (n = 102 196) Minnesota Student Surveys. Generalized estimating equations modeled eight adolescent tobacco use outcomes in 2019 (past 30-day use of any tobacco, cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, flavored tobacco, and multiple products) by T21 exposure, defined as respondents' attendance at a school within a jurisdiction with T21 policy implementation between the two surveys. Models controlled for demographic characteristics and product-specific baseline tobacco use at the school level in 2016 and were stratified by grade. RESULTS: After adjusting for baseline tobacco use and other demographics, T21-exposed eighth and ninth-grade students had significantly lower odds of tobacco use than unexposed peers in five of eight models, i.e. any tobacco (aOR = 0.80, 95% CI: 0.74, 0.87), cigarettes (aOR = 0.81, 95% CI: 0.67, 0.99), e-cigarettes (aOR = 0.78, 95% CI: 0.71, 0.85), flavored tobacco (aOR = 0.79, CI: 0.70, 0.89), and dual/poly tobacco (aOR = 0.77, 95% CI: 0.65, 0.92). T21-exposed eleventh-grade students did not differ significantly in their odds of any tobacco use outcomes relative to their unexposed peers. CONCLUSIONS: T21 exposure is associated with lower odds of multiple forms of tobacco use, particularly among younger adolescent populations, supporting the implementation of T21 policies to reduce tobacco use in this population.

Statewide Prevalence of Smoke-Free and Vape-Free Homes, by Tobacco Product Use, Minnesota, 2018.

INTRODUCTION: Securing clean indoor air laws is a major tobacco control accomplishment of the past 15 years. The public quickly adopted and supported such policies both in public and private spaces. Clean indoor air is now threatened by the emergence of e-cigarettes. E-cigarette aerosol contains nicotine, heavy metals, and carcinogens, and the long-term effect of secondhand exposure is unknown. Surveillance is necessary to track voluntary rules on smoking and vaping in the home. METHODS: The Minnesota Adult Tobacco Survey (MATS) is a series of cross-sectional, random-digit-dial telephone surveys on smoking, vaping, and other tobacco-related behaviors, attitudes, and beliefs among Minnesota adults. MATS measured voluntary smoke-free rules in the home in 2014 (N = 9,304) and measured both smoke-free and vape-free home rules in 2018 (N = 6,055). RESULTS: The prevalence of smoke-free home rules among Minnesota adults in 2018 was 91.5% (95% CI, 90.5%-92.5%), up slightly from 89.3% (95% CI, 88.4%-90.2%) in 2014. In comparison, 84.0% (95% CI, 82.7%-85.3%) reported vape-free home rules. Although 70.0% (95% CI, 66.0%-73.0%) of smokers in 2018 reported smoke-free home rules, only 23.3% (95% CI, 15.0%-31.6%) of e-cigarette users reported vape-free home rules. Living with children younger than 18 years significantly increased the odds of having smoke-free and vape-free home rules. CONCLUSION: Although widespread adoption of voluntary smoke-free and vape-free home rules demonstrates a positive change in social norms, most e-cigarette users allow vaping in their homes, including those who live with children younger than 18. Tracking voluntary smoke-free and vape-free home rules and efforts to encourage them are important to improve the public's health.

Location and duration of secondhand smoke exposure among Minnesota Nonsmokers, 2018.

In 2007 Minnesota passed into law a comprehensive ban on indoor smoking of tobacco products in public places including bars, restaurants, and workplaces. Despite reductions in smoking prevalence in the past 12 years, people are still exposed to secondhand smoke (SHS). It remains important to understand where and how long nonsmokers face exposure to SHS. The 2018 Minnesota Adult Tobacco Survey was analyzed to examine self-reported SHS exposure among nonsmoking adults. We report prevalence and 95 percent confidence intervals of SHS exposure overall, by specific locations, and by demographics. Length of exposure to SHS was summarized in median minutes. Overall, 30 percent of nonsmokers reported exposure in the past seven days. A total of 1382 participants indicated a location of exposure. The most common locations other than one's own home or car included building entrances (18.7 [16.2-21.1] percent), somewhere else outdoors (17.7 [15.1-20.3] percent), and restaurant/bar patios (12.8 [10.5-15.0] percent). Exposure was more likely to be reported by young adults (44.6 percent) and males (33.7 percent). The locations with the longest duration of SHS exposure in the prior seven days were a gambling venue (117.2 [72.2-162.2] minutes), another person's home (26.1 [15.4-36.8] minutes), and a bus stop (10.8 [4.7-16.9] minutes). Monitoring nonsmokers' self-reported exposure to SHS remains important as a way to measure the impact and compliance with smoke-free policies. Additional information on the location and duration of exposure can be used programmatically to address high levels of exposure and consider additional policies or strategies.

Who is using and why: Prevalence and perceptions of using and not using electronic cigarettes in a statewide survey of adults.

A statewide survey examined prevalence, reasons for using, discontinuing use, and not wanting to try e-cigarettes. METHODS: Participants (n = 6052) were adult Minnesota residents. E-cigarette initiation and current use prevalence rates were calculated for demographic characteristics and smoking status. The percent of respondents endorsing a reason for trying e-cigarettes are reported overall and by smoking status. The percent of respondents endorsing each reason for discontinuing or not using e-cigarettes are reported for daily and occasional smokers. All descriptive analyses were weighted. To develop profiles of e-cigarette users, a latent class analysis (LCA) was undertaken. RESULTS: Overall, 20.7% of adults reported ever use and 4.6% were current users. Use varied notably by age and smoking status. Only 2.8% of never smokers were current e-cigarette users. Among young adults, 14.6% reported current use but most (70.0%) were never smokers. The reasons given for using e-cigarettes varied by smoking status. Curiosity was the top reason for all groups except recent former smokers, for whom cutting down or quitting other tobacco products was primary. Most smokers discontinuing e-cigarettes preferred cigarettes, and four-fifths of smokers who never tried e-cigarettes lacked interest. From the LCA four profiles were evident: young adult experimenters, curious adults, smokers trying to quit cigarettes, and dual users. CONCLUSIONS: Innovative higher nicotine content devices have sustained interest in e-cigarettes especially among young adults and smokers with a goal of cutting down or quitting smoking. Future regulations and communication should focus on reducing e-cigarette use among young adult nonsmokers.

Changing patterns in E-cigarette use among Minnesota adults between 2014 and 2018.

Minnesota has observed declining combustible tobacco use and a large increase in e-cigarette use among youth and young adults. Less is known about adult e-cigarette users' frequency of use, smoking status, use of flavors, and demographic differences. The Minnesota Adult Tobacco Survey (MATS) is a cross-sectional, random digit-dial telephone survey representative of Minnesotans aged 18 and over. MATS measured e-cigarette use in 2014 (N = 9304) and 2018 (N = 6065). In 2018, 6.0% of adult Minnesotans used an e-cigarette in the past 30 days; this was unchanged from 2014 (5.9%). While past 30-day e-cigarette use declined for current smokers (2014: 27.3%; 2018: 16.1% p < 0.001), it increased for never smokers (2014: 1.2%; 2018: 4.4% p < 0.001) and 18-24-year-olds (2014: 12.8%; 2018: 21.9% p = 0.001). Daily e-cigarette use increased from 2014 to 2018 for current smokers (p = 0.001), 25-44-year-olds (p < 0.001), females (p = 0.001), and those with a high-school education (p = 0.006). Among e-cigarette users in 2018, use of flavored e-cigarettes was associated with smoking status (p = 0.041), age (p < 0.001), and using e-cigarettes to quit smoking (p = 0.011). E-cigarettes appeal primarily to younger adults. Of concern are increases in never smokers initiating e-cigarette use, increasing their exposure to nicotine, addiction, and the risk of future combustible tobacco use. Simultaneously, fewer smokers are using e-cigarettes but those who do are using them more frequently. Use of flavored e-cigarettes was common and correlated with interest in quitting combustible cigarettes. These findings can inform recent calls for additional tobacco control policy and programs aimed at reducing e-cigarette use.