Longitudinal patterns of cannabis and tobacco co-administration and concurrent use among young adult college students.

INTRODUCTION: Co-use, including concurrent use or co-administration, of cannabis and tobacco is most prevalent in young adulthood and associated with worse health outcomes than use of either substance alone. This study examined latent classes of tobacco and cannabis concurrent use and co-administration, and transitions between classes from 2016 to 2019, among a sample of young adult college students in Texas. METHODS: Participants included 4,448 young adults (64.2% female, 64.7% non-white, mean age = 20.5) in a longitudinal cohort study. Measures included past 30-day use of cigarettes. hookah, cigars, ENDS, cannabis, and cannabis and tobacco co-administration. Latent Markov models were used to estimate latent class membership and transitions between classes from 2016 to 2017 and 2017 to 2019. RESULTS: Four latent classes emerged: non-use (58% of students) characterized by low/no probability of any use; general use (19%) characterized by some level of use of all behaviors; blunt and cannabis use class (13%) characterized by high probabilities of cannabis use and co-administration with blunts; and concurrent and co-administration use (10%) with high probabilities of cigarette, cannabis, blunt, and spliff use. Most students remained in the same latent class from 2016 to 2019. CONCLUSIONS: While most students reported low/no tobacco and cannabis co-use, those who used cannabis and/or tobacco remained in their use classes over the course of the study (2016 to 2019). Public health advocates on college campuses should consider prevention and cessation programs that incorporate the constellation of behaviors related to cannabis and tobacco co-use and educate students about the health consequences of co-use.

Bidirectional associations between young adults' reported exposure to e-cigarette marketing and e-cigarette use.

AIMS: To examine bidirectional associations between self-reported exposure to electronic nicotine delivery system (ENDS) marketing and ENDS use, over four 6-month follow-up surveys, among young adults. DESIGN: The Marketing and Promotions Across Colleges in Texas project (M-PACT) is a cohort study that examined exposure to tobacco marketing and tobacco use behaviors among college students in Texas, United States. SETTING AND PARTICIPANTS: Participants were 5478 students from 24 2-year and 4-year Texas colleges. Approximately 64% (n = 3506) of the cohort were non-white, 64% were female and the average age was 20 years. MEASUREMENTS: Students completed a baseline survey in Fall 2014/Spring 2015 and three subsequent surveys 6 months apart. Items assessed current ENDS use and self-reported exposure to ENDS marketing through the point-of-sale, on television, on the radio, on the internet and on billboards. A multi-level cross-lagged path model was used to examine the bidirectional associations between self-reported exposure to ENDS marketing and current ENDS use across the four waves, controlling for socio-demographics. FINDINGS: Self-reported exposure to ENDS marketing at each previous wave predicted ENDS use at each subsequent wave (ß = 0.07-0.10, P < 0.001). ENDS use at waves 2 and 3 predicted self-reported exposure to ENDS marketing at wave 3 and 4, respectively (ß = 0.07-0.09, P < 0.001). Although ENDS users were more likely than non-users to report exposure to ENDS marketing, self-reported exposure to ENDS marketing predicted subsequent ENDS use controlling for prior ENDS use. CONCLUSION: Self-reported exposure to electronic nicotine delivery system (ENDS) marketing was bidirectionally associated with past 30-day use of ENDS among young adult college students in Texas, USA from 2014/15 to 2016.

Exposure to ENDS advertising and use of marijuana in ENDS among college students.

BACKGROUND: Factors associated with marijuana use in electronic nicotine delivery systems (ENDS) are largely unknown. ENDS advertising, through subtle normative cues as well as explicit and implicit messages suggesting ENDS products are socially condoned and healthier alternatives, may influence the use of marijuana in ENDS. The aim of our study was to examine the association between exposure to ENDS advertising and subsequent use of ENDS with marijuana among college students. METHODS: Data for this study were from waves 2 and 4 of the Marketing and Promotions across Colleges in Texas (M-PACT) study. Participants included 3720 college students (mean age = 21.4, SD = 2.3; 35.78% white; 35.7% male) across 24 colleges in Texas who completed online tobacco behavior surveys one year apart. Multilevel logistic regression was conducted to examine the association between ENDS advertising exposure at wave 2 (spring 2015) and use of marijuana in ENDS one year later at wave 4 (spring 2016), controlling for age, sex, race/ethnicity, and wave 2 sensation-seeking, impulsivity, current tobacco use, current marijuana use, and ever use of ENDS with marijuana. Use of ENDS to consume marijuana in the past six months was the outcome variable and ENDS advertising exposure was the independent variable. RESULTS: Nearly half of participants reported ever ENDS use at waves 2 and 4, and 10% used marijuana in ENDS in the past 6-months at wave 4. Multilevel logistic regression analyses indicated that for every unit increase in ENDS advertising exposure, the odds of subsequently using ENDS with marijuana one year later were 1.08 times (95% CI = 1.01-1.14) greater. CONCLUSIONS: ENDS advertising uniquely contributed to the subsequent use of marijuana in an ENDS, over and above the effects of other risk factors.

Exposure to tobacco and nicotine product advertising: Associations with perceived prevalence of use among college students.

OBJECTIVE: The purpose of this study was to examine the relationship between exposure to tobacco marketing and perceptions of peer tobacco use among college students. PARTICIPANTS: Participants were 5,767 undergraduate students from 19 colleges/universities in the State of Texas. METHODS: Students completed an online survey, in the spring of 2016, that assessed past 30 day exposure to e-cigarette, cigar, smokeless tobacco, and traditional cigarette advertising across multiple marketing channels, past 30 day use of each product, and perceived prevalence of peer use. Multi-level linear regression models were run to examine the associations between exposure to tobacco advertising and perceptions of peer tobacco use controlling for age, gender, race/ethnicity, use and school. RESULTS: Greater exposure to advertising was associated with greater perceived prevalence of peer use. CONCLUSIONS: Given the normative effects of advertising on perceived peer tobacco use, college tobacco initiatives should include descriptive norms education to counteract inaccurate perceptions.