Impulsivity-Related Personality Traits as Predictors of E-Cigarette Use among Young Adults over Time.

Introduction: There has been rising concern about e-cigarette usage among teenagers and young adults. As knowledge about the adverse health effects of e-cigarettes accumulates, it is critical to identify factors that may increase risk of vaping initiation and frequency of use. One potential risk factor known to increase risk for other substance use is impulsivity. This study tested the hypothesis that impulsivity prospectively predicts vaping over time. Methods: Active e-cigarette users (n = 137; 51.8% male; Mean age 20 years at baseline) completed 8 waves of assessment over 21 months (2017-2020). The S-UPPS-P impulse behavior scale was used at baseline to measure impulsivity, and frequency of e-cigarette, cigarette, marijuana and alcohol use was calculated at each wave thereafter. Results: Vaping frequency declined over time [Incidence Rate Ratio (IRR) = 0.92]. There were significant, stable, positive associations between e-cigarette use and lack of premeditation (IRR = 1.06) and sensation seeking (IRR = 1.09). Vaping frequency was inversely associated with negative urgency (IRR = 0.95). Positive urgency and lack of perseverance were not associated with frequency of vaping. Conclusion: These findings suggest that young adults who have higher impulsivity of certain types may use e-cigarettes more frequently. Thus, vaping interventions for young adults should address these factors to ensure the greatest impact on public health.

Post-legalization changes in marijuana use in a sample of young California adults.

INTRODUCTION: Increasing marijuana use among young adults is a concern due to substantial acute and chronic health risks. More widespread use of marijuana may also lead to increased use of nicotine and tobacco products. California legalized commercial sales of marijuana for recreational use as of January 2018. To our knowledge no studies to date have examined subsequent changes in marijuana use. The goal of this study was to test the hypothesis that marijuana use frequency increased following legalization of recreational sales. We also hypothesized that increased marijuana frequency would predict greater frequency of nicotine/tobacco consumption. METHODS: The study was a secondary analysis of a longitudinal study of tobacco use among non-daily cigarette smokers. Participants were 563 young adults (aged 18-24) enrolled in 2015-16 and followed quarterly for 3 years. RESULTS: A piecewise multilevel regression model indicated that marijuana use frequency did not change over time, including following legalization. More frequent use was associated with younger age and identifying as white (ps < 0.001, which did not change after legalization. Marijuana frequency was moderated by sex (p < .001), with women reporting increasing and men decreasing use over time. It was also associated with tobacco use, and particularly with e-cigarette use following legalization (ps < 0.05). CONCLUSIONS: Findings suggest legalization of recreational marijuana sales had a negligible overall impact on days of use among young adults, but may have prompted increased interest in marijuana among some, particularly women and e-cigarette users. The continuously evolving landscape around these products indicates that ongoing surveillance is critical.

Facilitating Change in Drinking Cognitions and Behaviors Among Three Immigrant Generations of Latinx Youth Through a School-Based Intervention: Findings From a Multi-Site Clinical Trial.

Latinx youth experience disparities in the availability of and participation in evidence-based interventions to reduce hazardous alcohol use. The aim of this secondary data analysis was to examine whether Project Options, a brief, evidence-based alcohol use intervention was beneficial for Latinx participants. A total of 331 first-, second-, and third-generation immigrant Latina and Latino youth who participated in a multi-site, hybrid effectiveness/efficacy clinical trial of the intervention were selected for analyses. Mixed-effects growth models tested changes in drinking cognitions (i.e., perception of peer drinking, intention to drink next month, alcohol use and cessation expectancies) and behaviors (i.e., number of past-month drinking days, average number of drinks per occasion, and maximum number of drinks per occasion) across three time points (i.e., baseline, 4-weeks, and 12-weeks). Consistent with prior Project Options studies, participants with more drinking experience reported greater decreases in perception of peer drinking, intentions to drink next month, and all drinking behaviors than those with less experience. While no changes were observed in expectancies, first-generation participants endorsed lower positive use expectancies than second- and third-generation youth as well as more favorable cessation expectancies than third-generation teens. In concert with prior studies demonstrating the intervention's success in recruitment and retention of Latinx participants, results suggest that Project Options might be a promising school-based intervention for Latinx youth. This intervention has the potential to reach adolescents who might otherwise not participate in traditional programming and help decrease disparities in availability of evidence-based practices for Latinx youth.

Co-occurring Use of Cannabis and Tobacco and the Presence of Acute Respiratory Symptoms among Young Adult Light and Intermittent Smokers.

BACKGROUND: Cannabis use and intermittent smoking are becoming increasingly prevalent among young adults. Thus, identifying health consequences of co-occurring use of these substances represents an emerging research priority. Purpose/Objectives: This study evaluated the relationship between tobacco/cannabis co-use and acute symptoms of respiratory illness among young adult intermittent smokers. We hypothesized that tobacco/cannabis co-use would be more strongly associated with respiratory symptoms relative to use of neither or one product. Methods: A secondary analysis of a three-year observational study was conducted. Non-daily smokers (n = 563) aged 18-24 were recruited via social media and completed electronic surveys at baseline and annually for two years, producing three total assessments. Past-two-week use of tobacco and cannabis was measured at each assessment, as was severity of six acute respiratory symptoms. The respiratory measure was dichotomized to indicate the presence or absence of symptoms. Results: Tobacco/cannabis co-use decreased from 54.8% at baseline to 43.4% at year two (p < .001). Mean respiratory symptoms also declined significantly over time (ps < .05). At each timepoint, co-use was more strongly associated with presence of respiratory symptoms than the use of neither product (aORs = 2.73-4.39, ps ≤ .013). Co-users were also 38%-183% more likely to endorse the presence of respiratory symptoms than single product users at each timepoint (aORs = 1.38-2.83, ps = .023-.212). Conclusions/Importance: Although co-occurring use of tobacco and cannabis by young adults may represent experimental use of multiple substances, it may also promote or exacerbate acute symptoms of respiratory illness. Further exploration with more granular patterns of co-use and across different routes of administration is warranted.

Associations Between Self-Reported and Biological Measures of Nicotine Consumption Among Young Adult Nondaily Cigarette Smokers.

BACKGROUND AND OBJECTIVES: Intermittent, dual use of cigarettes and e-cigarettes is a common pattern among youth and young adults. However, little is known about the validity of self-report measures of nicotine consumption in these populations. The goal of the present study was to examine associations between self-reported frequency of cigarette and e-cigarette use and nicotine levels in hair samples at two assessments 1 year apart. METHODS: Participants (n = 90; 65% female) were 19- to 25-year-old intermittent cigarette smokers recruited from the community for a longitudinal study of tobacco use. They submitted hair samples via mail, 1 and 2 years after enrollment in the parent study. RESULTS: Findings indicated that days of use of both cigarettes and e-cigarettes in the past 30 days independently predicted hair nicotine in the full sample, and when examining only timepoints at which any cigarette use was reported. Timepoints when any e-cigarette use was reported, hair nicotine was positively associated with e-cigarette but not cigarette frequency. DISCUSSION AND CONCLUSIONS: Data suggest that self-report measures are valid methods of assessing intermittent use of both cigarettes and e-cigarettes. Findings also suggest that dual users may tend to consume more nicotine and thus be at greater risk for dependence than single product users. SCIENTIFIC SIGNIFICANCE: These results are among the first to indicate that hair analysis can be used to detect intermittent nicotine exposure via both cigarettes and e-cigarettes. (Am J Addict 2020;29:471-475).

Enhancing engagement in evidence-based tobacco cessation treatment for smokers with mental illness: A pilot randomized trial.

OBJECTIVE: To evaluate the efficacy of a brief telephone-delivered Motivational Interviewing (MI)-based intervention to facilitate engagement in evidence-based cessation treatment for Veterans with mental illness referred to smoking cessation treatment. METHODS: 86 military Veteran smokers with mental illness were recruited from a tobacco cessation consult clinic and randomized to receive either a MI-based treatment engagement intervention (TE; n = 48) or a non-MI assessment and information control (CON; n = 38) condition. Intervention was delivered during a single brief telephone contact. Primary engagement outcomes were 1) attending a treatment session within 30 days and 2) combination treatment (attending session plus using pharmacotherapy). Cessation outcomes included self-reported 24 h cessation attempts and 7 day point abstinence at 3 months post-intervention. Outcomes were assessed at 1 and 3 months post intervention. RESULTS: Outcome analyses included 85 participants (47 TE, 38 CON) using an intent-to-treat analytic approach. Participants were on average 49.5 (13.4) years old, 88% Male, 59% white, 18% African American and 14% Hispanic/Latino(a). Following intervention delivery TE and CON participants did not differ on likelihood of attending a treatment session during the subsequent 30 days (47% vs 45%, respectively). A significant difference was observed when classified as utilizing combination treatment, 40% of TE versus 18% of CON reported use of smoking cessation medication and behavioral counseling (p = 0.04). No statistical differences were observed for cessation outcomes, although more TE than CON participants reported 7 day point abstinence at 3 months post-intervention (30% vs 18%). CONCLUSIONS: The present pilot study provides initial evidence for the feasibility, acceptability and efficacy of a telephone delivered TE intervention for enhancing engagement in combinationevidence evidence-based treatment in a sample of Veteran smokers with mental illness referred to smoking cessation treatment. Smokers with mental illness typically have greater difficulty stopping smoking than those without mental illness. Increased engagement in combination treatment thus has the potential to increase quit rates and ultimately reduce the burden of tobacco use for this population.

Polytobacco use among young adult smokers: prospective association with cigarette consumption.

BACKGROUND: The risks of polytobacco use among young adults are unclear because we know relatively little about the consistency of multiproduct patterns over time and how these patterns impact cigarette smoking. The purpose of this study was to examine changes in multiple tobacco product use over time and associations with cigarette smoking quantity. METHODS: Participants (n=335; 55% male) were 18-24 years old non-daily cigarette smokers living in California. Polytobacco use patterns were assessed quarterly for 2 years. RESULTS: Transition analyses showed that while the number of products that had been used recently was volatile, the most common pattern was stability between timepoints. A longitudinal negative binomial regression model indicated that those who used more non-cigarette products also reported greater cigarette quantity. The strength of this relationship increased over time. CONCLUSIONS: Findings suggest that individuals who use more tobacco products are at greater risk for increased cigarette smoking and maintaining a multiple product use pattern.

Marijuana use among young adult non-daily cigarette smokers over time.

Recent data regarding growth in concurrent use of nicotine and marijuana have raised concern that reductions in legal restrictions on marijuana use may increase risk for tobacco-related harms. Previous studies have shown cross-sectional links between use of both substances, but less is known about associations over time. The goal of the present study was to test the hypothesis that there is a bidirectional relationship between use of marijuana and use of tobacco products over time, such that increasing use of either substance would predict increasing use of the other. Participants (n = 391, 52% male) were 18-24 year-old Californians who were non-daily cigarette smokers at enrollment and had never been daily smokers. They reported nicotine/tobacco and marijuana use quarterly over 2 years. Longitudinal negative binomial and logistic regression models indicated that each additional timepoint at which participants reported recent marijuana use predicted 9-11% increases in tobacco quantity and frequency. Additionally, each additional timepoint at which cigarette or tobacco use was reported predicted 19-22% greater marijuana frequency. Data suggest that young adults who use marijuana more frequently are likely at risk for greater tobacco exposure, and vice versa. These findings suggest a need for preventive measures that focus on concurrent use of both substances rather than either individually.

Drinking refusal self-efficacy: Impacts on outcomes from a multi-site early intervention trial.

This study examines relationships between drink refusal self-efficacy (DRSE) and outcomes in Project Options (PO), an adolescent alcohol use early intervention. 1171 US high school students (39.3% Hispanic, 59.3% girls) participated in PO, reporting their demographics, alcohol use, and drinking reduction efforts at baseline, 30 days and three months later. Items from the Drug Taking Confidence Questionnaire for Adolescents (DTCQ-A) assessed DRSE. DRSE corresponded negatively with drinking at 30 days and, among drinkers, predicted fewer use reduction attempts at 30 days and three months. Results indicate that, unlike in treatment settings, DRSE may not correspond to improved early intervention outcomes.

Marijuana use among US tobacco users: Findings from wave 1 of the population assessment of tobacco health (PATH) study.

BACKGROUND: With an increase in marijuana use among adults in the United States (US), understanding the potential impact of marijuana use on tobacco use and associated behavioral and health consequences, including respiratory conditions, is necessary. METHOD: Survey responses from Wave 1 of the nationally representative Population Assessment of Tobacco and Health (PATH) Study were used to assess tobacco use and marijuana use among non-current tobacco users (n = 17,952) and current established tobacco-users classified as: cigarette only users (n = 8689), e-cigarette only users (n = 437), cigar only (traditional, cigarillo, or filtered) users (n = 706), hookah only users (n = 461), smokeless tobacco only users (n = 971), cigarette + e-cigarette users (n = 709), and users of multiple tobacco products (n = 2314). RESULTS: When compared to non-current tobacco users, each tobacco user group except smokeless only users had higher odds (odds ratios ranging from 3.86-8.07) of reporting current marijuana use. Among current tobacco users, higher levels of tobacco dependence did not explain the relationship between tobacco use and marijuana use. Additionally, concurrent marijuana use was associated with lower odds of attempts to quit tobacco (OR = 0.86, 95% CI = 0.79, 0.94, p < 0.001) and a higher probability (OR = 1.35, 95CI = 1.21, 1.51, p < 0.01) of reporting a history of respiratory disease. CONCLUSIONS: The association between concurrent use of tobacco and marijuana and higher tobacco dependence and lower rates of quit attempts suggests the potential for sustained tobacco use and deleterious health effects. Further, marijuana use may represent an additive risk for respiratory harm among concurrent users of tobacco and marijuana.

Combination nicotine replacement therapy: strategies for initiation and tapering.

Several studies and meta-analyses have demonstrated the efficacy of combination nicotine replacement therapy (NRT) for patients who wish to quit smoking. However, there is limited guidance with respect to initiation and tapering of combination NRT. We attempt to review the evidence and rationale behind combination NRT, present the dosing used in combination NRT studies, and propose a step-down approach for tapering of combination NRT with integration of behavioral strategies.

Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups.

Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e., where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e., African-American vs. Hispanic vs. non-Hispanic white). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic white majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic white groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

Factors Associated With Accepting Assistance for Smoking Cessation Among Military Veterans.

INTRODUCTION: Cigarette smoking remains a significant health risk for Veterans. Increased understanding of factors that influence the tobacco cessation referral process within Veterans Affairs medical facilities is useful for enhancing utilization of smoking cessation treatment. The present study examined the association of demographic and health variables with whether smokers accepted referral for medication and/or tobacco cessation clinic. METHODS: Electronic medical record data (2011-2013) were obtained for a sample of US military Veterans who accepted cessation assistance from their health care provider. Demographic and diagnostic variables were examined to identify predictors of the types of assistance accepted (medication only, clinic referral only, or both). RESULTS: The sample includes 2941 Veterans, 10.3% female, 19.9% African American, 10.7% Hispanic, and 57.9% non-Hispanic white. Veterans averaged of 50.69 years of age (SD = 14.01), 31.5% had a substance use disorder diagnosis and 54.1% had a psychiatric diagnosis. Demographic and diagnostic information was compared across types of assistance accepted. Significant differences were found between those who accepted medications only and those who accepted either clinic referral or both medication and clinic referral. Veterans in the latter two categories were younger and more likely to have a psychiatric diagnosis than those accepting medication only. Women Veterans were significantly more likely than men to accept clinic referral plus medication. However, in contrast to men, almost none of the variables examined were associated with the type of assistance accepted by women. CONCLUSION: These findings indicate significant gender differences in influences on accepting assistance for smoking cessation among Veterans. IMPLICATIONS: Existing research identifies factors associated with unassisted quitting. However, little is known regarding the referral process, which is critical in connecting smokers with treatment. The present work is unique in employing electronic medical record data to examine factors associated with accepting different types of smoking cessation treatment referrals. This study represents an initial effort to elucidate the smoking cessation treatment referral process. These findings highlight the need to examine sex specific influences on smoking cessation treatment utilization and the importance of focusing on smokers with psychiatric disorders.

Smoking prevalence in urban and rural populations: findings from California between 2001 and 2012.

BACKGROUND: Tobacco smoking and related health problems are still major public health concerns in the United States despite the declining smoking prevalence. OBJECTIVES: This study explored differences in smoking prevalence between urban and rural areas potentially relevant to tobacco control efforts in California. METHODS: Public use adult smoking data from the California Health Interview Survey (CHIS) between 2001 and 2011-2012 were analyzed. A total of 282 931 adults were surveyed across the six CHIS cycles. A ZIP code-based geographic classification (Urban, Second-City, Suburban, and Town/Rural) was used to examine the association between smoking prevalence and area of residency. RESULTS: The overall smoking prevalence in California decreased from 17.0% in 2001 to 13.8% in 2011-2012. Within each CHIS cycle, the Town/Rural areas had the highest smoking prevalence, followed by Urban and Second-City areas, and Suburban areas had the lowest. Pooled data from all CHIS cycles showed a similar pattern, with rates in Urban, Second-City, Suburban and Town/Rural areas being 15.2%, 15.2%, 13.1% and 17.3%, respectively. Weighted multivariate logistic regression analysis indicated significantly higher odds of smoking in Urban, Second-City and Town/Rural areas compared to Suburban areas (all adjusted odds ratios > 1.10), although this trend varied by race/ethnicity, being present in non-Hispanic Whites and not present in Hispanics. CONCLUSIONS: Town/Rural and Urban populations of California are consistently at higher risk of smoking than Suburban populations. These results indicate a need for population-specific tobacco control approaches that address the lifestyle, behavior, and education of disparate populations within the same state or region.

Feasibility and Reliability of a Coding System to Capture In-Session Group Behavior in Adolescents.

Limited research has explored the role of in-session behavior during motivational enhancement (ME) in group formats. The current study presents initial feasibility of assessing behavior of high school students (N = 425) attending Project Options, a voluntary secondary drug and alcohol prevention program utilizing ME techniques. Building on previous research exploring client language supporting/opposing health behavior, student group behavior was coded live at the specific utterance and global level; group leader behavior was also coded globally. Interrater reliability of the coding system was assessed, and preliminary validity of the coding system was examined by exploring associations between characteristics of group members and in-session group behavior. Initial reliability estimates were excellent for the specific behavior codes. Reliability of the global codes was mixed, with raters demonstrating good reliability on support for unhealthy behavior, opposition to unhealthy behavior, and support for healthy behavior. Reliability of the group leader codes was fair to poor. Greater percent healthy talk was associated with a lower percentage of group members reporting lifetime alcohol use. The results of the current study suggest that some in-session behavior at the group level can be coded reliably via live observation and that in-session behavior at the group level is associated with alcohol use prior to attending the program. Future research is needed to explore the utility of in-session behavior in terms of predicting future behavior at the group and individual level.

E-cigarette use in the past and quitting behavior in the future: a population-based study.

OBJECTIVES: We examined whether smokers who used e-cigarettes are more likely to quit after 1 year than smokers who had never used e-cigarettes. METHODS: We surveyed California smokers (n = 1000) at 2 time points 1 year apart. We conducted logistic regression analyses to determine whether history of e-cigarette use at baseline predicted quitting behavior at follow-up, adjusting for demographics and smoking behavior at baseline. We limited analyses to smokers who reported consistent e-cigarette behavior at baseline and follow-up. RESULTS: Compared with smokers who never used e-cigarettes, smokers who ever used e-cigarettes were significantly less likely to decrease cigarette consumption (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.30, 0.87), and significantly less likely to quit for 30 days or more at follow-up (OR = 0.41; 95% CI = 0.18, 0.93). Ever-users of e-cigarettes were more likely to report a quit attempt, although this was not statistically significant (OR = 1.15; 95% CI = 0.67, 1.97). CONCLUSIONS: Smokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings, which need to be confirmed by longer-term cohort studies, have important policy and regulation implications regarding the use of e-cigarettes among smokers.

Predicting use of assistance when quitting: a longitudinal study of the role of quitting beliefs.

BACKGROUND: A growing literature addresses the need to reduce cigarette smoking prevalence by increasing the use of assistance when quitting. A key focus is to identify strategies for enhancing adoption of effective interventions in order to increase utilization of evidence-based treatments. PURPOSE: To examine the effect of beliefs regarding ability to quit on utilization of assistance for smoking cessation. A mediation model was hypothesized whereby the relationship between smoking and use of assistance is influenced by beliefs in ability to quit. METHODS: The present study includes 474 of 1000 respondents to baseline and follow-up California Smokers Cohort surveys conducted from 2011 to 2013. Included were baseline smokers who reported a 24-h quit attempt at follow-up. Baseline variables were used to predict use of assistance when quitting. RESULTS: The hypothesized model was tested using a product of coefficients method, controlling for demographics. Greater heaviness of smoking and lower belief in ability to quit were significantly related to use of assistance. Quitting beliefs significantly mediated the relationship between nicotine dependence and use of assistance. CONCLUSIONS: The present data support a mechanism whereby the effect of smoking rate on treatment utilization is mediated by beliefs in ability to quit. Greater belief in one's ability to quit may represent an obstacle to treatment utilization by reducing the likelihood of successful cessation. The present findings suggest the value of targeted messages from health care providers that normalize the need for assistance when attempting to change an addictive behavior and emphasize the difficulty of quitting without assistance.