E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors.

BACKGROUND: Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use. METHODS: An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17/04/2023 and 04/11/2023. RESULTS: A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants' smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant's smoking status, the mother's smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value < 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%). CONCLUSION: This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students' knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.

Association between health-related social media use and E-cigarette use among current cigarette users: the roles of anti-tobacco messages and harm perception.

BACKGROUND: The popularity of e-cigarettes is on the rise among current cigarette users. Therefore, there are concerns about their health implications. This study examined the impact of health-related social media use on e-cigarette use among current cigarette users. It assesses the mediating influence of online anti-tobacco messages and the moderating role of the harm perception of e-cigarettes. METHODS: This study was focused on 563 current cigarette users from the 2022 Health Information National Trends Survey (HINTS). Three tasks were performed: (1) assessing the direct and indirect impacts of health-related social media use on e-cigarette use among current cigarette users, (2) exploring the mediating role of exposure to online anti-tobacco messages, and (3) examining the moderating influence of e-cigarette harm perception on the path from anti-tobacco messages to e-cigarette use. RESULTS: Health-related social media use was positively associated with current cigarette users' e-cigarette use directly (bp = 0.183, p < .01) and indirectly through exposure to online anti-tobacco messages (bp = 0.023, 95% CI: [0.001, 0.051]). Harm perception of e-cigarettes moderated the relationship between online exposure to anti-tobacco messages and e-cigarette use (bp=-0.467, p < .01). The relationship appeared weaker for individuals who perceived greater harm from e-cigarettes. CONCLUSIONS: Health-related social media use positively correlates with e-cigarette use among current cigarette users through exposure to online anti-tobacco messages. The perceived harm of e-cigarettes moderates this indirect path. These findings have implications for public health interventions aimed at smoking cessation.

Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study.

BACKGROUND: Although electronic cigarettes (e-cigarettes) appear to be effective in helping people who smoke to stop smoking, concerns about use of e-cigarettes among young people have led to restrictions on non-tobacco flavoured e-liquids in some countries and some US states. These restrictions could reduce the appeal of these products to non-smoking youth but could have negative consequences for people who smoke or use e-cigarettes. METHODS: In this mixed methods study, we recruited UK adults who smoked or used to smoke and subsequently vaped to explore their opinions of unflavoured e-liquids and their beliefs about how they would be impacted by hypothetical e-liquid flavour restrictions. Participants trialled an unflavoured e-liquid instead of their usual nicotine product for four hours and completed a survey and an online interview. RESULTS: Using Interpretive Phenomenological Analysis and graphically presented data, we found differences in participants' opinions of unflavoured e-liquid. If only unflavoured, tobacco flavoured, and menthol flavoured e-liquids remained on the UK market, some people who smoke or vape may be unaffected, but some may relapse to smoking or continue smoking. Despite most wanting to prevent young people from initiating vaping, participants had varying opinions on whether flavour restrictions would be an effective method. CONCLUSIONS: The findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping).

How healthcare providers and the right information may play a critical role in quitting success among smokers interested in using e-cigarettes for quitting: Results from a survey of U.S adults.

INTRODUCTION: Promoting smoking cessation is a global public health priority. E-cigarettes are increasingly being used by individuals to try quitting smoking. Identifying sources and types of information available to adults who are trying to quit, and the impact of this information during a quit attempt, is critical to augment the potential public health benefit of e-cigarettes for reducing cigarette smoking. METHODS: US adults (N = 857) who reported using e-cigarettes in a recent smoking cessation attempt completed an anonymous, cross sectional, online survey. We examined sources of information and type of information received when using e-cigarettes to quit smoking and their associations with the duration of abstinence achieved. RESULTS: The two most commonly reported information sources were friends (43.9%) and the internet (35.2%), while 14.0% received information from a healthcare provider. People received information on type of device (48.5%), flavor (46.3%), and nicotine concentration (43.6%). More people received information about gradually switching from smoking to vaping (46.7%) than abruptly switching (30.2%). Obtaining information from healthcare providers (ß (SE) = 0.16 (0.08), p = 0.04), getting information about abruptly switching to e-cigarettes (ß (SE) = 0.14 (0.06), p = 0.01) and what nicotine concentrations to use (ß (SE) = 0.18 (0.05), p = 0.03) were associated with longer quit durations. CONCLUSIONS: Amidst the growing popularity of e-cigarettes use for quitting smoking, our results highlight common sources of information and types of information received by individuals. Few people received information from healthcare providers indicating a gap in cessation support that can be filled. Providing information about immediate switching to e-cigarettes and nicotine concentrations to use may help in increasing quit rates and duration.

Menthol versus tobacco e-liquid flavor: Impact on acute subjective effects, puff patterns, and intentions for use among Black and White menthol smokers.

BACKGROUND: The proposed FDA product standard to prohibit menthol as a characterizing flavor in combustible cigarettes has the potential to significantly reduce tobacco-related health disparities. Whether a menthol e-liquid product standard would improve or hinder public health is unknown. No known research has directly examined the impact of menthol vs. tobacco flavored e-liquid use on acute e-cigarette use patterns, subjective experience, behavioral intentions, and craving and withdrawal among menthol cigarette smokers. METHODS: Black (n = 47) and White (n = 4) nicotine-deprived menthol smokers with limited e-cigarette experience completed two counterbalanced in-laboratory 30-minute ad libitum vaping sessions with menthol and tobacco nicotine salt-based e-liquid in a randomized crossover pilot trial design. Questionnaires assessed reductions in craving and withdrawal and post-session subjective experience and behavioral intentions. Puff topography was measured continuously throughout each vaping session. RESULTS: Measures of puff topography did not differ significantly by e-liquid flavor (all p > .40). Similarly, menthol and tobacco flavored e-cigarettes were both rated positively in terms of subjective effects and behavioral intentions (all p > .10) and about 40 % of participants reported a preference for the tobacco-flavored e-liquid. Finally, participants showed comparable reductions in craving (p = .210) and withdrawal (p = .671) from pre- and post-session regardless of e-liquid flavor. CONCLUSIONS: Among menthol smokers in a lab-based setting, findings suggest that menthol vs tobacco e-liquid flavor has little impact on acute changes in puff patterns, subjective experience, behavioral intentions, or craving and withdrawal.

E-cigarette use reasons and associated e-cigarette use dependence among college students: A longitudinal examination.

OBJECTIVE: Previous studies have established an understanding of reasons for e-cigarette use and associated e-cigarette use patterns such as use frequency, yet the critical extension to associated e-cigarette dependence outcome remains under-researched. This study used longitudinal data to examine whether the reasons for e-cigarette use predict a higher/lower level of e-cigarette dependence. METHODS: This study recruited college students who were current e-cigarette users from Fall 2019 to Fall 2020 (four semesters) at three public universities in the Midwest and South of the U.S. Those who participated for at least two semesters were included (N = 366). Data were collected using a structured questionnaire. E-cigarette use dependence was assessed using the Penn State Electronic Cigarette Dependence Index. A linear mixed model with a random intercept and a random slope was conducted to examine the longitudinal association between reasons for e-cigarette use and dependence, controlling for demographics and other covariates. RESULTS: Participants who used e-cigarettes for relaxation (ß = 0.63, p < 0.05) and due to their good taste (ß = 0.63, p < 0.05) had a higher level of e-cigarette dependence. Participants using e-cigarettes for experimental purposes had a lower level of e-cigarette dependence (ß = -1.21, p < 0.01). CONCLUSIONS: These findings highlight the importance of addressing e-cigarette use reasons and their relationship to e-cigarette dependence. Prevention and intervention efforts aimed at developing more effective strategies should consider the various e-cigarette use reasons associated with dependence risks, such as enhancing awareness of the use dependence risk related to good taste of e-cigarettes and use for relaxation, as well as incorporating early screenings for use.

Does sensation-seeking behavior influence the patterns of flavored e-cigarette use? A cross-sectional study among Indonesian adolescents and young adults.

BACKGROUND: The variety of available flavors in e-cigarettes may be a driver for young people to start using these products. The objectives of our study were to examine the relationship between sensation-seeking behavior and e-cigarette use, and to identify the predictors of flavor use patterns among adolescents in Indonesia. METHODS: Students aged 15 to 24 years participated from randomly selected high schools and universities in Indonesia. Participants answered questions about their demographic data, e-cigarette use, conventional cigarette use, and sensation-seeking. Flavor preferences were identified from eight different flavor categories. Multivariate multinomial regression analysis was employed to predict conventional cigarette and e-cigarette use among students. A latent class analysis was conducted to determine the number of latent classes of flavor use. RESULTS: One thousand six hundred high school and university students, with a mean age of 18.2 years (SD 2.19), were recruited between March and August, 2023. Conventional cigarette use in the past 30 days was higher (16.3%) compared to e-cigarette use (13.3%, p = 0.017), with approximately 8.5% of students were being dual users. Higher levels of sensation-seeking significantly increased the odds of being a current e-cigarette user (OR = 2.54, 95%CI 1.99-3.25) and a current conventional cigarette smoker (OR = 2.38, 95%CI 1.85-3.07). Three groups of flavor classes were identified: 1) primarily menthol flavor users (14%), who had a strong association with current conventional cigarette use; 2) experimenters, who mostly preferred fruit-flavored e-cigarettes (76%); and 3) the multi-flavor user group (10%), who had a higher sensation-seeking tendency. CONCLUSIONS: Flavors, especially menthol and fruit flavors, attract youth, broaden the e-cigarette audience and are particularly appealing to high sensation-seekers. Banning these flavors could significantly deter e-cigarette initiation among youth.

Identifying promising themes and messages for youth vaping prevention: A national study.

Use of e-cigarettes and vapes among adolescents continues to be a major public health concern. Health communication efforts can discourage e-cigarette use among adolescents by influencing beliefs and behavior. However, to do so, studies need to identify the most promising themes and messages based on the latest evidence about the harms of e-cigarettes and vaping. Participants were a nationally representative sample of 1,603 US adolescents aged 13-17 years, recruited in the summer of 2022. Adolescents were randomly assigned to view 7 vaping prevention statements (one from each theme: nicotine addiction, chemical harms, health symptoms, mental health, organ effects, cosmetic effects, and monetary cost) and 1 control statement (vape litter theme) from a pool of 46 statements that were developed through a systematic process. Participants rated each statement on perceived message effectiveness (PME), awareness, and believability. Results of linear mixed models indicated that all vaping prevention themes out-performed control messages on PME, with chemical harms and organ effects having the largest effects, followed by nicotine addiction and then other themes. For most message themes, PME effects were stronger for youth susceptible to vaping compared to non-susceptible youth and users. Both awareness and believability predicted higher levels of PME. In secondary analyses, we found that statements specifying the target ("you") and longer statements were also rated higher on PME. Results suggests that the most potent vaping prevention messages for adolescents are those that focus on vape chemicals and the potential of vaping to damage organs and increase disease risk.

Uncontrolled vaping and restraint strategies: A qualitative study.

INTRODUCTION: Little is known about uncontrolled vaping, defined as vaping more than the user prefers. We sought to understand e-cigarette users' experiences with uncontrolled vaping and how they restrain their vaping. METHODS: Participants were 24 US adult e-cigarette users recruited in 2021. We conducted semi-structured qualitative interviews about uncontrolled vaping and restraint strategies and analyzed findings based on behavioral categories described in the Process Model of Self-Control. RESULTS: While most participants (21 of 24) described experiences of uncontrolled vaping, some expressed ambivalence about how much they vaped. To restrain vaping, willpower was rarely used and was not perceived as effective. Distraction, deployment of attention away from the urge to vape, and reappraisal, thinking differently about vaping such as reminding oneself of health consequences, were common and helped some participants limit use in the moment of wanting to vape. Participants described using both situation selection, choosing to be in situations where e-cigarette use was less possible, and situation modification, modifying their circumstances to restrict opportunities to vape. DISCUSSION: Uncontrolled vaping is not yet a well-defined concept for many e-cigarette users. E-cigarette users employed proactive situational strategies that required planning ahead to restrain use and found these strategies more effective compared to reactive strategies. Tobacco control programs and interventions should consider leveraging restraint strategies that people who vape are naturally using and perceive to be effective.

Attitudes, Behaviors, and Perceptions of Students Vaping in Three Mexican Universities.

The increase in the popularity and use of electronic cigarettes (e-cigarettes) has consistently risen worldwide and has become associated with adverse health outcomes. This study has identified the attitudes and perceptions of undergraduate students who vape in three universities in Mexico. A cross-sectional study involving 495 participants was conducted using a survey from October to December 2023. Three universities in different states in Mexico collaborated with colleges in Yucatan, Durango, and Nuevo Leon, Mexico. Descriptive statistics include frequencies and percentages, and four logistic regression models were employed. In the sample, 31% and 17.54% of participants reported smoking and vaping, respectively. Students who reported vaping in the last month reported that their first experience with vaping was at an average of 17.3 years of age, and of those, 71.26% (n = 62) reported having vaped for over 100 days, while the remaining 38% reported vaping for between 2 and 100 days. Students from Veracruz and Yucatan began vaping at a younger age than in the central and northern regions. There is a need to educate students about the dangers of the chemicals in the liquids they use, the secondary exposure vapers, and the health dangers they pose.

The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada.

BACKGROUND: Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days. METHODS: Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS: Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use. CONCLUSIONS: The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.

Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users.

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Does source matter? Examining the effects of health experts, friends, and social media influencers on young adult perceptions of Instagram e-cigarette education messages.

PURPOSE: Young adults' e-cigarette use is a leading public health concern. Using messages from credible sources can help improve message acceptance, yet little research has examined the role of source credibility on young adults' responses to e-cigarette education messages. METHODS: We examined the impact of source on young adults' perceptions of e-cigarette education messages and e-cigarettes. In July 2022, we conducted an experimental study using an online sample of young adults (N=459, Mage=24.6) who were randomized to one of three source conditions: expert, friend, or influencer, and viewed e-cigarette education messages. We used one-way ANOVA to estimate the association between the conditions and outcomes (perceived source credibility, message trust, curiosity, use interests, perceived message effectiveness, beliefs, harm perceptions, and intentions to refrain). RESULTS: The expert condition was associated with significantly higher perceived source credibility (vs. friend, influencer; p<0.001), message trust (vs. friend, influencer; p<0.001), and curiosity (vs. influencer; p's<0.05). CONCLUSIONS: Public health campaigns may leverage health experts to deliver e-cigarette education messages targeting young adults to improve effectiveness of the messages.

Methodological considerations when assessing symptoms of nicotine dependence by cigarette and e-cigarette use behavior and brand.

Letter to the Editor re: Adjei et al., 2024. Symptoms of nicotine dependence by e-cigarette and cigarette use behavior and brand: A population-based, nationally representative cross-sectional study. Drug and Alcohol Dependence 255, 111059 concerning issues of context, citations, non-psychometrically validated dependence items, and disclosure transparency.

Vaping in mental health inpatient units: A qualitative study of consumer and staff views on electronic nicotine delivery systems.

OBJECTIVES: The aim of this qualitative study was to explore the subjective experiences of consumers and staff members regarding the availability of electronic nicotine delivery systems (ENDS) in inpatient mental health units. METHODS: Mental health consumers and staff members (n = 16) from rehabilitation and forensic inpatient units were interviewed in 2022. Thematic analysis of the transcripts was undertaken. RESULTS: Our study identified four themes: The high salience of nicotine use in inpatient units, delivering nicotine in a resource scarce environment, weighing up the harms of ENDS as a smoking cessation tool, and a need for fair and consistent policy. CONCLUSIONS: The main positive aspects identified were recognition of rights of consumers, a relative harm reduction compared to tobacco use, and ENDS as a positive factor in the therapeutic relationship. The main challenges identified were resourcing issues, ENDS being a potential source of tension and conflict and a lack of overarching policy guiding their use.

Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations.

BACKGROUND: Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS: This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS: Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION: California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.

Emotion Dysregulation and E-Cigarette Expectancies among College Student E-Cigarette Users.

Background: E-cigarette outcome expectancies (i.e., beliefs about the expected consequences of e-cigarette use) are a key factor in motivating use. Emotion regulation difficulties have demonstrated significant associations with outcome expectancies; however, there has yet to be an examination of associations between specific emotion regulation difficulties and specific e-cigarette outcome expectancies, which could serve as targets for intervention efforts. Therefore, the current study sought to examine the unique predictive ability of specific emotion regulation difficulties in terms of e-cigarette outcome expectancies. Methods: Participants were 116 college student e-cigarette users (Mage = 19.72, SD = 1.88; 71.6% female) who completed self-report questionnaires for course credit. Results: Greater difficulties engaging in goal-directed behavior when experiencing negative emotions and fewer difficulties accessing effective emotion regulation strategies were associated with positive reinforcement outcome expectancies. Greater emotion regulation difficulties in general were also associated with negative reinforcement outcome expectancies, though there were no significant individual predictors. Conclusion: These results suggest that greater emotion regulation difficulties are associated with mood-related e-cigarette outcome expectancies, and targeting emotion regulation difficulties, particularly difficulty engaging in goal-directed behavior when upset, may be useful to incorporate into intervention efforts.

Examining the prevalence of nicotine vaping and association of major depressive episodes among adolescents and young adults by disability type in 2021.

BACKGROUND: Nicotine vaping is more prevalent among U.S. adults with disabilities compared to those without disabilities. However, less is known about nicotine vaping among adolescents (12-17 years) and young adults (18-25 years) by disability status. METHODS: Using data from a sample of 24,722 adolescents and young adults (AYAs) from the 2021 National Survey on Drug Use and Health, we conducted descriptive and multivariable analyses to estimate the national prevalence of nicotine vaping by disability type and examined major depressive episodes (MDEs) as a risk factor for nicotine vaping. RESULTS: A greater proportion of AYAs with disabilities engaged in past-month nicotine vaping compared to those without a disability (13.9 % vs 9.6 %, p = 0.0001). Also, when MDE was excluded from the model, AYAs with any disability had higher odds of nicotine vaping (AOR = 1.41; 95 % CI 1.15, 1.74) than those without a disability. However, disability status was no longer significant when MDE was included (AOR = 1.16; 95 % CI 0.91, 1.46) in the model. CONCLUSIONS: The higher prevalence of nicotine vaping among AYAs with disabilities suggests that tailored messages may be needed to communicate health risks and adverse outcomes of e-cigarette use. Also, MDE is associated with nicotine vaping among AYA populations. This information can be helpful to school nurses, counselors, and mental health professionals in their screening of major depression as a risk factor for e-cigarette use.

E-cigarette use or dual use of E-cigarette and combustible cigarette and mental health and cognitive impairment: Findings from the National Health Interview Survey, 2020-2021.

BACKGROUND: Studies on the association between e-cigarette use and mental health are mostly among adolescents and young adults, leaving limited evidence of this association among general US adults. Besides, few studies have examined how e-cigarette use or dual use of e-cigarette and combustible cigarette is related to cognitive function. METHODS: Cross-sectional data of 56,734 adults from the 2020-2021 National Health Interview Survey were analyzed. Weighted multivariable logistic regression models were applied to examine the independent association between e-cigarette use or dual use and anxiety symptoms, depression symptoms, serious psychological distress (SPD), and cognitive impairment. RESULTS: Compared with never e-cigarette users, current e-cigarette users had 2.10-fold (95 % CI: 1.84, 2.39), 2.53-fold (95 % CI: 2.13, 3.00), 2.02-fold (95 % CI: 1.47, 2.76), and 2.00-fold (95 % CI: 1.47, 2.72) higher odds of reporting anxiety symptoms, depression symptoms, SPD, and cognitive impairment, respectively. Former e-cigarette use was also associated with all three mental conditions and cognitive impairment (AOR ranged from 1.38 to 2.53, all P < 0.01). Dual users were more likely to report all three mental conditions and cognitive impairment than those who never used combustible cigarette and e-cigarette (AOR ranged from 1.89 to 2.83, all P < 0.01). Dual users also had a greater likelihood of having anxiety or depression symptoms than exclusive combustible cigarette users (AOR ranged from 1.46 to 1.47, all P < 0.01). CONCLUSIONS: E-cigarette use or dual use is associated with poor mental health and cognitive impairment among US adults. Regulations on e-cigarette use are needed to prevent mental illness and improve cognitive function.

Effects of Nicotine Content and Preferred Flavor on Subjective Responses to E-cigarettes: A Randomized, Placebo-controlled Laboratory Study.

INTRODUCTION: Evidence suggests that e-liquid flavor and nicotine concentration are important factors in the initiation and maintenance of e-cigarette use (vaping). Flavors may increase the initiation and maintenance of vaping, and nicotine content is a factor in e-cigarette dependence and the efficacy of e-cigarettes for cigarette smoking cessation. Few human laboratory studies have assessed the joint and interactive effects of flavor and nicotine on subjective responses to e-cigarettes. METHODS: Regular e-cigarette users (N = 89) completed a multi-session study involving a paced vaping procedure with e-liquid cartridges containing their preferred flavor (berry, menthol, or tobacco) or no flavor, with or without nicotine (18 mg). Subjective effects of vaping (satisfaction, reward, aversion, airway sensations, and craving relief) were assessed. RESULTS: Nicotine significantly increased psychological reward and craving relief, whereas flavor significantly increased vaping satisfaction and taste. Nicotine dependence severity moderated the effect of nicotine on reward, such that those with the greatest dependence severity reported the greatest reward. CONCLUSIONS: These findings support differential and noninteractive effects of e-liquid nicotine content and flavor on reinforcing effects of e-cigarettes. IMPLICATIONS: E-liquid flavor and nicotine content have independent, non-interactive effects on subjective responses to vaping under controlled laboratory conditions. Among regular e-cigarette users, vaping a preferred flavor increased taste and satisfaction, but did not interact with nicotine to alter reward or craving. Further research on the ways in which these subjective effects may motivate vaping behavior among different populations of e-cigarette users would be useful to inform regulatory policy of ENDS products.