E-Cigarette Brand Use by Race/Ethnicity in a US Sample of Adolescent and Young Adult E-Cigarette Users, 2022-2023.

INTRODUCTION: To determine whether e-cigarette brand use varies according to race/ethnicity among adolescent and young adult e-cigarette users. AIMS AND METHODS: Data are from a cross-sectional online survey of respondents aged 15-24 years (January 2022-June 2023; 300 unique respondents/week). The analytic sample was restricted to current e-cigarette users (n = 6387). Respondents selected their usual brand and reported frequency of past 30-day e-cigarette use (in days). ANOVAs measured differences in frequency of use by usual brand, stratified by race/ethnicity. Linear regression identified changes in usual brand over time by race/ethnicity, controlling for age and use of other tobacco/nicotine products. RESULTS: One-quarter (25.6%) of Black and 22.2% of Hispanic e-cigarette users reported JUUL as their usual brand, compared to those who are White (15.7%) or another race (16.5%). Puff Bar was the second-most reported brand among Black (15.1%) or Hispanic (16.6%) e-cigarette users, to a greater extent than White (7.8%) e-cigarette users. Frequency of use varied significantly according to respondents' usual brand when stratified by race/ethnicity (p < .001). CONCLUSIONS: Across all racial and ethnic categories, frequency of use was greater for brands marketed with more flavor options and containing nicotine (EB Design, SMOK, Hyde, and Vuse). Despite declines in popularity, Black or Hispanic respondents report using JUUL and Puff Bar to a greater extent than other respondents, and vape less frequently than White non-Hispanic respondents regardless of brand. As e-cigarette brands continue to proliferate, monitoring e-cigarette brand selection by race/ethnicity can inform studies of nicotine exposure, polyuse, and health disparities. IMPLICATIONS: Our study demonstrates the importance of research methods to detect rapidly changing patterns of e-cigarette use by race/ethnicity and age. The inclusion of measures capturing brand use can detect evidence of product features and targeted marketing that may have consequences for patterns of tobacco use and nicotine exposure among these groups.

Developing a National Longitudinal Tobacco Cohort of Youth and Young Adults: The Tobacco Epidemic Evaluation Network (TEEN+) Study.

INTRODUCTION: Timely and relevant data are critical to monitoring the rapidly changing youth vaping epidemic and for understanding the prevalence, patterns of use, knowledge, and perceptions of tobacco products. While e-cigarettes have been the most used tobacco product among youth for nearly a decade, new nicotine delivery products continue to be introduced to the US market. Flavored tobacco products, including flavored e-cigarettes, menthol cigarettes, and flavored cigars, drive disparities in use by young people. AIMS AND METHODS: To examine tobacco use among youth and young adults, the Monitoring E-Cigarette Use among Youth project established a longitudinal cohort of youth and young adults (13-24)-the Tobacco Epidemic Evaluation Network (TEEN+) study. TEEN+ focuses on e-cigarette and other tobacco products use and also includes questions about other substance use (eg, marijuana, alcohol), physical health, mental health, and social determinants of health (eg, discrimination, poverty, sexual and gender identity). Geocoding of responses allows for the evaluation of local tobacco control policies. The cohort includes an oversample of California residents to generate reliable and representative state-level estimates. This manuscript provides an overview of methods and baseline demographics from Wave 1. RESULTS: The initial Wave 1 TEEN+ cohort included 10 255 in the national sample and 2761 in the California sample. CONCLUSIONS: TEEN+ study data complement nationally-representative cross-sectional studies and allow for rapid evaluation of local and state policies. This manuscript describes the study's probability-based sample recruitment. Furthermore, we identify this initiative as a resource for evaluating the impact of flavored tobacco restriction policies and informing policy implementation efforts. IMPLICATIONS: This manuscript provides an overview of the methodology and baseline characteristics for a new longitudinal cohort of youth and young adults, the Tobacco Epidemic Evaluation Network (TEEN+) study. The TEEN+ study data can be used to evaluate the impact of flavored tobacco product restriction policies and informing policy implementation efforts.

Youth and young adult flavour expectancies for new 'non-menthol' cigarettes introduced following California's ban on flavoured tobacco products.

BACKGROUND: Following California's statewide law prohibiting the sale of flavoured tobacco products, some cigarette brands introduced new variants advertised as non-menthol, yet featuring design and text commonly found in menthol cigarette marketing. METHODS: Data are from the February-May 2023 wave of the Tobacco Epidemic Evaluation Network (TEEN+) national probability-based survey (aged 13-25 years). Respondents (N=10 217) were shown images of two (of four) 'new non-menthol' brand ads or packaging and two comparators ('classic' non-menthol and menthol cigarette brands). Respondents reported expected taste of each (no or any minty/menthol taste; 'don't know'). Multinomial regression models tested associations between predictors (age, gender identity, race and ethnicity, perceived financial situation, smoking status) and expectation of minty/menthol taste. RESULTS: Younger age was associated with expectations of minty/menthol taste, controlling for covariates. Respondents aged 13-17 years had greater odds of expecting minty/menthol taste than no minty/menthol taste for all tested new non-menthol brands (Camel Crush Oasis adjusted OR (aOR): 1.30, p<0.05; Camel Crisp aOR: 1.47, p<0.001; Kool Non-Menthol Blue aOR: 1.27, p<0.05; Kool Non-Menthol Green aOR: 1.43, p<0.01), compared to respondents aged 21 and older. Respondents aged 18-20 years had greater odds of reporting minty/menthol expectancies than no minty/menthol expectancies for Camel Crush Oasis (aOR: 1.35, p<0.05) and Kool Non-Menthol Green (aOR: 1.29, p<0.05) compared to those aged 21-25 years. Compared to non-Hispanic white respondents, non-Hispanic Asian respondents had greater odds of expecting minty/menthol taste than no minty/menthol taste for Camel Crush Oasis (aOR: 1.89, p<0.01), Kool Non-Menthol Blue (aOR: 1.88, p<0.01) and Kool Non-Menthol Green (aOR: 1.72, p<0.05). DISCUSSION: Younger age was associated with expectations of new non-menthol cigarettes having a minty/menthol taste. Results raise concerns regarding the potential appeal of these products to youth and young adults.

Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment.

BACKGROUND: e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery. OBJECTIVE: The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping. METHODS: Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned. RESULTS: The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (ß=-0.138, 95% CI -0.266 to -0.010; P=.04) and anti-industry beliefs (ß=-0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus. CONCLUSIONS: Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668.

Youth and Young Adult Blunt Use Predicts Progression to Other Nicotine Product Use in the United States.

BACKGROUND: Little cigars or cigarillos (LCCs) are frequently modified to smoke cannabis ("blunts") by youth and young adults. This study investigated whether young blunt users who are otherwise nicotine-naïve are more likely to initiate other tobacco products compared to never blunt users. METHODS AND MATERIALS: Data were from four waves of the Truth Longitudinal Cohort (TLC), a national probability-based sample of youth and young adults (aged 15-24 years) in the United States (Wave 1: January-April 2017; Wave 2: February-May 2018; Wave 3: February-May 2019; Wave 4: September-December 2019). The sample was restricted to nicotine naïve respondents at Wave 1 with possible ever use of blunts (N = 5,284). Logistic regression analyses tested whether ever blunt use at Wave 1 predicted initiation of nicotine products by Wave 4, controlling for established risk factors. RESULTS: Compared to never-blunt users, ever users of blunts at Wave 1 had significantly higher odds of ever using cigars (OR: 4.74; 95% CI: 1.80-12.47; p = 0.002), e-cigarettes (OR: 4.66; 95% CI: 2.42-8.95; p < 0.001), cigarettes (OR: 3.02; 95% CI: 1.17-7.84, p = 0.023), or hookah (OR: 3.47; 95% CI: 1.07-11.29, p = 0.039) by Wave 4. Cannabis (never blunt) use by Wave 1 predicted ever use of e-cigarettes (OR: 3.45, 95% CI: 2.38-5.02, p < 0.001), cigarettes (OR: 3.81; 95% CI: 2.26-6.43, p < 0.001), or hookah (OR: 2.13; 95% CI: 1.12-4.05, p = 0.021) by Wave 4. DISCUSSION: Blunts are a point of nicotine initiation that places users at increased risk of progression to cigars, while the same relationship was not found for cannabis alone.

Perceived Sensory Characteristics of Blended and Ambiguous "Concept" Flavors Among Adolescent and Young Adult E-cigarette Users.

INTRODUCTION: Flavors with names describing blended tastes/sensations or with ambiguous terminology ("concept flavors") are available on the e-cigarette market. AIMS AND METHODS: This study investigates adolescent and young adult use and sensory perceptions of blended and concept flavors. Current e-cigarette users aged 15-24 years (N = 2281) completed an online convenience sample survey (October 20-November 23, 2020) and rated the sensory attributes (fruity, cooling, sweet, and minty) of their current flavor(s) using nine-point scales. T-tests compared mean sensory perception scores within and between flavors. To compare concept flavors to blends, reference categories used the average of blends with relevant descriptors: fruit (Banana Ice, Iced Mango, Melon Ice, Cool Cucumber); cooling (Banana Ice, Iced Mango, Melon Ice, Blue B Ice, Cool Cucumber, Lush Ice, and Menthol Purple); sweet (Vivid Vanilla) and mint (Mint-sation). RESULTS: Most respondents had used at least one product with blended descriptors (74.8%) or concept flavor (57.9%) in the past 30 days. All flavors had high perceived strength for at least two sensory attributes. Mint taste was not perceived to be a strong sensory characteristic for all but two flavors (Mint-sation and Winter) in the study. The most commonly used flavors used blended descriptors (Iced Mango was used by 30.2% of the sample; Banana Ice: 26.2%; Lush Ice: 23.8%; Melon Ice: 22.9%). Some concept flavors did not significantly differ from flavor blend reference categories for strength of: fruit taste (Bahama Mama and Tropic); cooling sensation (Marigold, Island Breeze, Winter); sweet taste (Bahama Mama, Honeymoon, Island Breeze, Island Cream, Meteor Milk, OMG, Royal Dagger and Tropic); and mint taste (Winter). CONCLUSIONS: Blended and concept flavors are used by most young e-cigarette users, who describe these products as fruity, sweet, and cooling. A variety of flavored products with high youth appeal are available in the U.S. market. IMPLICATIONS: This study of adolescent and young adult e-cigarette users finds evidence of the popularity of e-cigarette flavors combining a cooling sensation with fruity and sweet flavorings. Some products with this flavor profile do not use characterizing descriptors. Findings inform public health interventions intended to reduce e-cigarette use in young people.

Reducing e-cigarette use among youth and young adults: evidence of the truth campaign's impact.

BACKGROUND: Mass media campaigns have been shown to be effective in reducing cigarette use. However, evidence is limited for whether campaigns can shift e-cigarette use among youth and young adults (YYA). To assess the impact of the truth anti-e-cigarette campaign, which focused on the effects of vaping on mental health, this study examines the relationship between campaign awareness and e-cigarette behaviour among YYA. METHODS: Data from weekly cross-sectional surveys of YYA aged 15-24 years from September 2021 to October 2022 were used for multilevel models assessing how weekly campaign awareness is related to intentions to use e-cigarettes and current e-cigarette use (past 30 days). Weekly campaign awareness was calculated by averaging individual-level awareness for each week. Control variables included individual-level campaign awareness, sociodemographics, perceived financial situation, parental smoking, sensation seeking, and mental health. RESULTS: Weekly campaign awareness ranged from 50% to 78%, with most weeks (77%) being within 65% and 75% of weekly campaign awareness. At weekly awareness levels between 65% and 75%, there was a significant association with lower intentions to use e-cigarettes. A dose-response relationship was observed for current use: compared with weeks with lower (<65%) awareness, weeks with awareness of 65-70% had 14% lower odds of current use, weeks with 70-75% awareness had 16% lower odds and weeks with >75% weekly awareness had 18% lower odds (p=0.018, p=0.009 and p=0.007, respectively). CONCLUSIONS: Findings from this analysis of weekly campaign awareness demonstrate that exposure to the truth anti-e-cigarette campaign is associated with significantly lower odds of intentions to use and current use of e-cigarette among YYA.

Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults.

OBJECTIVE: Antismoking mass media campaigns have contributed to significant declines in combustible tobacco use among young people. This study evaluates a national anti-e-cigarette campaign to determine its association with knowledge, attitudes and beliefs in the context of increasing e-cigarette use in the USA. METHODS: A national sample of respondents aged 15-24 years (n=8421) was drawn from a repeated cross-sectional online panel survey (220 participants/week) (October 2018 to December 2019). Self-reported exposure to the truth anti-e-cigarette campaign was measured according to level of ad awareness. Outcomes were subjective knowledge of campaign-targeted facts about e-cigarettes and attitudinal constructs about perceived e-cigarette harm, social unacceptability and anti-industry sentiments. Covariates included respondent demographics, current e-cigarette use and cigarette use, parental smoking, sensation seeking, mental health and growth in e-cigarette sales. RESULTS: Ad awareness was associated with knowledge that e-cigarette users are more likely to start smoking (low OR: 1.28, 95% CI 1.14 to 1.44; high OR: 1.88, 95% CI 1.66 to 2.13) and of the nicotine content of JUUL compared with cigarettes (low OR: 1.63, 95% CI 1.45 to 1.82; high OR: 2.50, 95% CI 2.21 to 2.84). High ad awareness was associated with knowledge that the long-term health effects of JUUL use are unknown (OR: 1.88, 95% CI 1.57 to 2.28). High ad awareness was associated with significantly higher perceived product harm (OR: 1.35, 95% CI 1.18 to 1.54), social unacceptability (OR: 1.32, 95% CI 1.15 to 1.53) and anti-industry attitudes (OR: 1.40, 95% CI 1.21 to 1.62), compared with respondents with no awareness. CONCLUSIONS: Young people with awareness of anti-e-cigarette ads demonstrate higher levels of campaign-targeted knowledge, attitudes and beliefs. Future campaign evaluation priorities include measuring the campaign effects on e-cigarette use behaviours.

Relative increases in direct-to-consumer menthol ads following 2020 FDA guidance on flavoured e-cigarettes.

OBJECTIVE: To examine potential changes in email and direct mail advertisements for flavoured e-cigarettes following the 2020 Food and Drug Administration (FDA) flavour guidance. METHODS: Digital copies of e-cigarette advertisements were obtained from Mintel Comperemedia (November 2019-May 2020) and coded for the presence of flavours. Χ2 tests were used to determine changes in the prevalence of email and direct mail advertisements for e-cigarettes with menthol, non-menthol and no flavours. RESULTS: Following FDA guidance, the relative proportion of menthol-flavoured e-cigarette advertisements sent via email significantly increased from 22.5% to 52.2%. No changes were found for e-cigarette advertisements mentioning no flavours, nor non-menthol-flavoured e-cigarettes, sent via email or direct mail. CONCLUSIONS: The 2020 FDA flavour guidance was followed by an increased proportion of direct-to-consumer email advertisements of menthol-flavoured e-cigarette products.

Use of a multi-method approach to rapidly assess the impact of public health policies at the state and local level: a case study of flavored e-cigarette policies.

BACKGROUND: E-cigarettes are the most-commonly used tobacco product by youth since 2014. To prevent youth access and use of e-cigarettes, many U.S. states and localities have enacted policies over a relatively short period of time. The adoption of these policies has necessitated timely data collection to evaluate impacts. METHODS: To assess the impact of flavored e-cigarette policies in select states and local jurisdictions across the United States, a multi-method, complementary approach was implemented from July 2019 to present, which includes analyses of cross-sectional online surveys of young people ages 13-24 years with retail sales data. RESULTS: From February 2020 through February 2023, cross-sectional surveys have been conducted in three cities, one county, and eight states where policy changes have been enacted or are likely to be enacted. Data collection occurred every six months to provide near real-time data and examine trends over time. Additionally, weekly retail sales data were aggregated to showcase monthly sales trends at the national level and for the selected states. DISCUSSION: This rapid and efficient method of coupling online survey data with retail sales data provides a timely and effective approach for monitoring a quickly changing tobacco product landscape, particularly for states and localities where rapidly-available data is often not available. This approach can also be used to monitor other health behaviors and relevant policy impacts.

Cigar Use Progression Among New Cigar Initiators: A Two-Part Growth Curve Analysis Among a Youth and Young Adult Cohort.

INTRODUCTION: Youth and young adults (YYAs) are at high risk of cigar use. This study's objective was to examine progression and sociodemographic differences in current cigar use and frequency among new cigar initiators. AIMS AND METHODS: We conducted a two-part latent growth model among a nationally representative cohort of cigar initiators (aged 15-25) to examine 24-month trajectories of current cigar use and frequency (n = 1483). The cohort was recruited via address-based sampling with online data collection from 2014 to 2019 and surveyed approximately every 6 months. RESULTS: The unconditional odds of current cigar use (ie, past 30-day use) within 6 months of initiation was 0.72 (95% confidence interval: 0.63, 0.82), corresponding to a probability of 42%. The odds of current use among recent cigar initiates declined 6 months after initiation and was followed by a stabilization in use over time. Among continued users, frequency (# days used in past 30 days) increased linearly over time but remained low (3.47 days/months at 24 months). Younger individuals, non-Hispanic African Americans, those with lower subjective financial status, and current users of cigarettes, other tobacco products and/or marijuana were at highest risk within 6 months of initiation. Males, younger users, and current cigarette smokers had the highest risk for cigar progression over time. CONCLUSIONS: This study is the first to examine longitudinal cigar use patterns among YYA cigar initiators. Findings emphasize the need for research across the cigar use spectrum and the importance of interventions targeted by age, stage of use, cigarette, other tobacco, and marijuana use and key sociodemographics to interrupt use pathways. IMPLICATIONS: This study is the first to examine progression of cigar use among YYAs who have newly initiated cigars. Results show a high probability of current cigar use within 6 months of initiation followed by a rapid decline and stabilization over time. Frequency increases among those who continue using cigars. Males, younger users, and current cigarette smokers had the highest risk for cigar progression over time. Findings emphasize the need for targeting interventions by age, stage of use, cigarette, other tobacco, and marijuana use and key sociodemographics to interrupt use pathways.

Youth and young adult risk perceptions and behaviours in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA.

OBJECTIVE: To determine whether awareness of emerging vaping-attributable health conditions influences vaping-related risk perceptions and behaviours among young people. DESIGN: Respondents aged 15-24 years (n=3536) were drawn from a repeated cross-sectional online panel survey (222 participants/week) during an e-cigarette/vaping-associated lung injury (EVALI) outbreak in the USA (September 2019-January 2020). Logistic regression models tested for associations between EVALI awareness and perceived lung injury risk and product harm, stratified by e-cigarette/vape use and controlling for awareness of other e-cigarette/vaping news stories, demographic characteristics and outbreak week. Other models measured the association between perceived risk of lung injury and intentions to use (non-users) or intentions to quit (current users) e-cigarettes/vape products. Changes in national retail e-cigarette sales data were examined during national EVALI outbreak reporting. RESULTS: EVALI awareness was associated with: perceived risk of lung injury (current users OR 1.59, p=0.004; non-users OR 2.11, p<0.001); belief that e-cigarettes/vapes contain dangerous chemicals (current users OR 1.47, p=0.017; non-users OR 1.88, p<0.001) and belief that e-cigarettes/vapes are harmful (current users OR 1.66, p=0.002; non-users OR 1.67, p<0.001). Perceived risk of lung injury from e-cigarette/vape use was associated with intentions to own e-cigarette/vape products (ever-users OR 0.25, p<0.001; never-users OR 0.61, p=0.004) and intentions to quit among current users (OR 2.02, p=0.002). Declines in e-cigarette sales were observed following news of the EVALI outbreak. CONCLUSIONS: News of vaping-attributable health conditions may prevent e-cigarette/vape use and encourage cessation among young people. Tobacco control campaigns should address uncertain health effects of e-cigarettes or vape products and align with risk communication by public health agencies during outbreaks.

Evidence of the impact of a national anti-tobacco prevention campaign across demographic subgroups.

Mass media campaigns are an effective population-level intervention for preventing tobacco use. However, little evidence exists for whether these campaigns similarly influence demographic subgroups. This study examined the effects of the truth® campaign to reduce tobacco use among demographic subgroups. We used data from a national, continuous, cross-sectional tracking survey of 15-24-year-olds (n = 32 331). We used a measure of weekly aggregated campaign exposure to assess whether cigarette smoking intentions and current cigarette use varied by race/ethnicity, financial situation and population density subgroups, controlling for factors known to be associated with tobacco use. Examining estimates across subgroup categories in light of the overall model estimates revealed that the effects of week-level campaign exposure on cigarette smoking intentions and current cigarette use were similar across subgroups. Wald tests of equality across estimates in each subgroup suggested that the estimates did not differ from one another in any given instance. The truth campaign does not differ significantly in its capacity to prompt declines in tobacco use across a broad spectrum of US youth and young adults. Mass media tobacco prevention campaigns can be an effective and critical component of a comprehensive tobacco control program, particularly with respect to reducing tobacco-related disparities among demographic subgroups.

Influence of Flavors and Nicotine Concentration on Nicotine Dependence in Adolescent and Young Adult E-Cigarette Users.

Objective: The objective of this study is to examine the relationships between e-cigarette flavors, nicotine concentration, and their interaction on measures of nicotine dependence.Methods: Survey data are drawn from a cross-sectional convenience sample of past 30-day e-cigarette users aged 15 to 24 years (N = 2037) collected between October 2020 and November 2020. Participants were asked to provide information about the e-cigarette products they used most regularly. Only those with available information on flavors (fruit, mint, menthol/ice, and tobacco), nicotine concentration (0-2.9%, 3-4.9%, and 5% or greater), and time to first vape after waking (within 30 minutes, greater than 30 minutes) were included in analyses (N = 1430). Generalized linear regression models were used with log link and binary distribution to assess the relationship between flavors, nicotine concentration, and nicotine dependence. Effect modification by nicotine concentration was assessed using an interaction term for flavors by nicotine concentration. Models were adjusted for age, race/ethnicity, gender, and financial situation.Findings: Fruit, mint, and menthol flavor user groups had a very similar dose-response relationship between nicotine concentration and prevalence of vaping within 30 minutes. These groups showed that the prevalence of vaping within 30 minutes gradually increased as nicotine concentration increased. Meanwhile, tobacco flavor user groups demonstrated a decrease in prevalence of vaping within 30 minutes, as nicotine concentration increased.Conclusion: Results highlight the need for understanding how e-cigarette product characteristics like flavors and nicotine concentration can facilitate nicotine dependence to e-cigarettes. Findings suggest that comprehensive e-cigarette product regulation of all flavors and reducing nicotine concentration will help to reduce the risk for nicotine dependence among young people.

E-Cigarette Use Among Youths and Young Adults During the COVID-19 Pandemic: United States, 2020.

Objectives. To determine whether the COVID-19 pandemic affected e-cigarette use among young people in the United States.Methods. Data came from a weekly cross-sectional online survey of youths and young adults (aged 15-24 years). Logistic regression analyses measured odds of past-30-day e-cigarette use (n = 5752) following widespread stay-at-home directives (March 14-June 29, 2020), compared with the pre‒COVID-19 period (January 1-March 13, 2020). Logistic regression among a subsample of current e-cigarette users (n = 779) examined factors associated with reduced use following stay-at-home orders.Results. Odds of current e-cigarette use were significantly lower during the COVID-19 pandemic compared with the pre‒COVID-19 period among youths aged 15 to 17 years (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.96) and young adults aged 18 to 20 years (OR = 0.65; 95% CI = 0.52, 0.81). E-cigarette users with reduced access to retail environments had higher odds of reporting reduced e-cigarette use (OR = 1.51; 95% CI = 1.07, 2.14).Conclusions. COVID-19 stay-at-home directives present barriers to e-cigarette access and are associated with a decline in e-cigarette use among young people.Public Health Implications. Findings support the urgent implementation of interventions that reduce underage access to e-cigarettes to accelerate a downward trajectory of youth and young adult e-cigarette use.

Early Evidence of an Opioid Education Campaign: A Case Study of Rhode Island.

CONTEXT: The opioid crisis poses a significant burden at a national level, and certain states have seen particularly high rates of misuse, addiction, and overdose. In 2017, Rhode Island reported opioid-related deaths nearly twice the national average. OBJECTIVE: To test message efficacy and evaluate the effectiveness of campaign messaging to shift attitudes/beliefs related to opioid misuse in Rhode Island. DESIGN: In phase 1, near-final versions of 6 advertisements were shown to a sample of the target audience via an online survey portal to assess responses to the messages (N = 1210). Phase 2 of the study employed a pre/posttest design whereby 2 cross-sectional surveys were conducted, first prior to the campaign launch (N = 456) and another survey 6 months later in Rhode Island (N = 433). SETTING: Phase 1 was conducted online using a nationally representative panel, and phase 2 included a convenience sample of participants in Rhode Island recruited to undergo an online survey. PARTICIPANTS: Eighteen- to 29-year-old members of a nationally representative online panel (phase 1) and 15- to 34-year-olds living in the state of Rhode Island during data collection periods. MAIN OUTCOME MEASURE(S): Empathy and destigmatization ("someone like me could become addicted..." and "those who are dependent on prescription opioids are victims") and perceived risk of developing dependence on opioids. RESULTS: In both phases, there was an increase in empathy ("someone") (phase 1: pretest [31%], posttest [42%; z = 5.5, P < .0001] and phase 2 [34% baseline vs 41% follow-up; z = 2.0, P = .04]) and destigmatization ("victims") (phase 1: pretest [54%], posttest [58%; z = 2.2, P = .01] and phase 2 [46% baseline vs 54% follow-up; z = 2.2, P = .03]). There was also an increase in perceived risk: phase 1 (pretest [65%], posttest [75%; z = 5.4, P < .0001]) and phase 2 (66% baseline vs 74% follow-up; z = 2.5, P = .01). CONCLUSIONS: This study demonstrated the potential efficacy of a media campaign to shift young adults' opioid-related attitudes.

Developing effective communication materials on the health effects of climate change for vulnerable groups: a mixed methods study.

BACKGROUND: Individuals with chronic health conditions or low socioeconomic status (SES) are more vulnerable to the health impacts of climate change. Health communication can provide information on the management of these impacts. This study tested, among vulnerable audiences, whether viewing targeted materials increases knowledge about the health impacts of climate change and strength of climate change beliefs, and whether each are associated with stronger intentions to practice recommended behaviors. METHODS: Low-SES respondents with chronic conditions were recruited for an online survey in six cities. Respondents were shown targeted materials illustrating the relationship between climate change and chronic conditions. Changes in knowledge and climate change beliefs (pre- and post-test) and behavioral intentions (post-test only) were tested using McNemar tests of marginal frequencies of two binary outcomes or paired t-tests, and multivariable linear regression. Qualitative interviews were conducted among target audiences to triangulate survey findings and make recommendations on the design of messages. RESULTS: Respondents (N = 122) reflected the target population regarding income, educational level and prevalence of household health conditions. (1) Knowledge. Significant increases in knowledge were found regarding: groups that are most vulnerable to heat (children [p < 0.001], individuals with heart disease [p < 0.001], or lung disease [p = 0.019]); and environmental conditions that increase allergy-producing pollen (increased heat [p = 0.003], increased carbon dioxide [p < 0.001]). (2) Strength of certainty that climate change is happening increased significantly between pre- and post-test (p < 0.001), as did belief that climate change affected respondents' health (p < 0.001). (3) Behavioral intention. At post-test, higher knowledge of heat vulnerabilities and environmental conditions that trigger pollen allergies were associated with greater behavioral intention scores (p = 0.001 and p = 0.002, respectively). In-depth interviews (N = 15) revealed that vulnerable audiences are interested in immediate-term advice on health management and protective behaviors related to their chronic conditions, but took less notice of messages about collective action to slow or stop climate change. Respondents identified both appealing and less favorable design elements in the materials. CONCLUSIONS: Individuals who are vulnerable to the health effects of climate change benefit from communication materials that explain, using graphics and concise language, how climate change affects health conditions and how to engage in protective adaptation behaviors.