Reasons for Electronic Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey, United States, 2016.

Electronic cigarettes (e-cigarettes) were the most commonly used tobacco product among U.S. middle school and high school students in 2016 (1). CDC and the Food and Drug Administration (FDA) analyzed data from the 2016 National Youth Tobacco Survey (NYTS) to assess self-reported reasons for e-cigarette use among U.S. middle school (grades 6-8) and high school (grades 9-12) student e-cigarette users. Among students who reported ever using e-cigarettes in 2016, the most commonly selected reasons for use were 1) use by "friend or family member" (39.0%); 2) availability of "flavors such as mint, candy, fruit, or chocolate" (31.0%); and 3) the belief that "they are less harmful than other forms of tobacco such as cigarettes" (17.1%). The least commonly selected reasons were 1) "they are easier to get than other tobacco products, such as cigarettes" (4.8%); 2) "they cost less than other tobacco products such as cigarettes" (3.2%); and 3) "famous people on TV or in movies use them" (1.5%). Availability of flavors as a reason for use was more commonly selected by high school users (32.3%) than by middle school users (26.8%). Efforts to prevent middle school and high school students from initiating the use of any tobacco product, including e-cigarettes, are important to reduce tobacco product use among U.S. youths (2).

Potential deaths averted in USA by replacing cigarettes with e-cigarettes.

INTRODUCTION: US tobacco control policies to reduce cigarette use have been effective, but their impact has been relatively slow. This study considers a strategy of switching cigarette smokers to e-cigarette use ('vaping') in the USA to accelerate tobacco control progress. METHODS: A Status Quo Scenario, developed to project smoking rates and health outcomes in the absence of vaping, is compared with Substitution models, whereby cigarette use is largely replaced by vaping over a 10-year period. We test an Optimistic and a Pessimistic Scenario, differing in terms of the relative harms of e-cigarettes compared with cigarettes and the impact on overall initiation, cessation and switching. Projected mortality outcomes by age and sex under the Status Quo and E-Cigarette Substitution Scenarios are compared from 2016 to 2100 to determine public health impacts. FINDINGS: Compared with the Status Quo, replacement of cigarette by e-cigarette use over a 10-year period yields 6.6 million fewer premature deaths with 86.7 million fewer life years lost in the Optimistic Scenario. Under the Pessimistic Scenario, 1.6 million premature deaths are averted with 20.8 million fewer life years lost. The largest gains are among younger cohorts, with a 0.5 gain in average life expectancy projected for the age 15 years cohort in 2016. CONCLUSIONS: The tobacco control community has been divided regarding the role of e-cigarettes in tobacco control. Our projections show that a strategy of replacing cigarette smoking with vaping would yield substantial life year gains, even under pessimistic assumptions regarding cessation, initiation and relative harm.

Addictive behaviors, social and psychosocial factors, and electronic cigarette use among adolescents: a population-based study.

OBJECTIVES: The aim was to investigate associations between e-cigarette use and social and psychosocial factors and cigarette smoking, alcohol consumption, and narcotics use among adolescents attending 9th grade in primary school and 2nd grade in secondary school. STUDY DESIGN: Cross-sectional study. METHODS: The public health survey among adolescents in Scania in 2016 includes pupils in grades 9 and 2. The associations between e-cigarette use and lifestyle, social and psychosocial factors, and trust were investigated with logistic regressions. RESULTS: In 9th grade, 32% of male pupils and 27% of female pupils had ever used e-cigarettes, and in 2nd grade, 43% of males and 31% of females had ever used e-cigarettes. E-cigarette use was significantly associated with current smoking, snus (a moist powder tobacco product originating in Sweden) use, water pipe use, intensive alcohol consumption, and narcotics and also with psychosocial conditions related to home and parents, peers, and school. CONCLUSIONS: The prevalence of ever e-cigarette use was high among adolescents attending both grades. E-cigarette use was most strongly associated with health-related lifestyles. It was also associated with psychosocial factors such as study difficulties, school stress, problems talking with parents, and generalized trust.

Electronic Cigarette Use in US Adults at Risk for or with COPD: Analysis from Two Observational Cohorts.

BACKGROUND: Electronic cigarettes (e-cigarettes) are battery-operated nicotine-delivery devices used by some smokers as a cessation tool as well as by never smokers. OBJECTIVE: To determine the usage of e-cigarettes in older adults at risk for or with chronic obstructive pulmonary disease (COPD). DESIGN: Prospective cohorts. PARTICIPANTS: COPDGene (N = 3536) and SPIROMICS (N = 1060) subjects who were current or former smokers aged 45-80. MAIN MEASURES: Participants were surveyed to determine whether e-cigarette use was associated with longitudinal changes in COPD progression or smoking habits. KEY RESULTS: From 2010 to 2016, participants who had ever used e-cigarettes steadily increased to 12-16%, but from 2014 to 2016 current use was stable at ~5%. E-cigarette use in African-Americans (AA) and whites was similar; however, AA were 1.8-2.9 times as likely to use menthol-flavored e-cigarettes. Current e-cigarette and conventional cigarette users had higher nicotine dependence and consumed more nicotine than those who smoked only conventional cigarettes. E-cigarette users had a heavier conventional cigarette smoking history and worse respiratory health, were less likely to reduce or quit conventional cigarette smoking, had higher nicotine dependence, and were more likely to report chronic bronchitis and exacerbations. Ever e-cigarette users had more rapid decline in lung function, but this trend did not persist after adjustment for persistent conventional cigarette smoking. CONCLUSIONS: E-cigarette use, which is common in adults with or at risk for COPD, was associated with worse pulmonary-related health outcomes, but not with cessation of smoking conventional cigarettes. Although this was an observational study, we find no evidence supporting the use of e-cigarettes as a harm reduction strategy among current smokers with or at risk for COPD.

Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults.

Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N=9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006-2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p<0.0001), particularly among adults aged 18-24 and 25-44. Most prevalent were "e-cig," "electronic cigarettes", and "vape," with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word "vape", and less likely to have "e-cig" and "electronic cigarette" than records of adults (ps<0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes.

To vape or not to vape? Effects of exposure to conflicting news headlines on beliefs about harms and benefits of electronic cigarette use: Results from a randomized controlled experiment.

News coverage of novel tobacco products including e-cigarettes has framed the use of these products with both positive and negative slants. Conflicting information may shape public knowledge, perceptions of e-cigarettes, and their harms. The objective of this study is to assess effects of exposure to conflicting news coverage on US adults' beliefs about harms and benefits of e-cigarette use. We conducted a one-way between-subjects randomized controlled experiment in 2016 to compare the effects of viewing either 1) positive, 2) negative, 3) both positive and negative (conflicting) news headlines about the safety of using e-cigarettes, or 4) no-message. Participants were 2056 adults aged 18 and older from an online survey panel. Outcomes were beliefs about harms (3-item scale, α=0.76) and benefits (3-item scale, α=0.82) of using e-cigarettes. Participants who viewed negative headlines reported increased beliefs about harms (B=0.164, p=0.039) and lower beliefs about benefits of e-cigarette use (B=-0.216, p=0.009), compared with those in the positive headlines condition. These differences were replicated in subgroup analyses among never e-cigarette users. In addition, never e-cigarette users who viewed conflicting headlines reported lower beliefs about benefits of e-cigarette use (B=-0.221, p=0.030) than the positive headlines condition. Valence of news coverage about e-cigarettes (positive, negative, or conflicting) could influence people's beliefs about harms and benefits of e-cigarette use.

Vape Shop Density and Socio-Demographic Disparities: A US Census Tract Analysis.

INTRODUCTION: Vape shops are an emerging business specializing in the sales and promotion of e-cigarette, e-juice, and other vaping products. This study sought to evaluate the associations between vape shop density and socio-demographic characteristics at the US census tract level. METHODS: Vape shop data (n = 9943) were collected from three online directories: Yelp.com, Yellowpages.com, and Guidetovaping.com. Addresses of vape shops were geocoded and the density per 10 000 people was estimated at each US census tract. Zero inflated negative binomial regression model was performed to examine the socio-demographic factors associated with vape shop density. RESULTS: Overall, there was a higher vape shop density in urban versus nonurban census tracts. In urban areas, higher vape shop density was associated with larger proportions of Hispanics and Asians, adults aged 18-44 years old and higher poverty, while the decrease in vape shop density was associated with larger proportions of population under 18 years old, higher education, larger household size, and a higher percentage of owner occupied housing units. In nonurban areas, higher vape shop density was associated larger proportions of African Americans and Hispanics, smaller household size and a lower percentage of owner occupied housing units. CONCLUSION: At the national level, there are inequalities of vape shop density by some socio-demographic characteristics and heterogeneity between urban and nonurban areas. IMPLICATIONS: Vape shops are more likely to be concentrated in areas where people with a higher risk for vaping and smoking reside. Our findings could inform initiatives aimed at a stronger licensing requirement for vape shops and federal and state-level regulations of this industry to prevent vape shop from targeting minority and other socially disadvantaged groups.

Could Vaping be a New Weapon in the Battle of the Bulge?

IMPLICATIONS: Obesity is set to overtake tobacco smoking in many countries as the primary cause of several high-cost diseases. Tobacco smoking mitigates weight gain through nicotine's effect on the brain and metabolism. Smoking, however, is associated with many illnesses and premature death and appropriately has been discouraged leading to declining prevalence rates. This article explores the emerging perception that vaping electronic cigarettes with nicotine and flavors could deliver similar appetite and weight control effects as smoking. The potential to reduce risks associated with excess weight deserves exploration. An initial research agenda is suggested.

E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups.

OBJECTIVE: To assess whether electronic cigarette (e-cigarette) awareness, 'ever use' and current use vary significantly between different sociodemographic groups. DESIGN: Systematic review. DATA SOURCES: Published and unpublished reports identified by searching seven electronic databases (PubMed, MEDLINE, Web of Science, EMBASE, Global Health, PsycINFO, CINAHL Plus) and grey literature sources. STUDY SELECTION: Systematic search for and appraisal of cross-sectional or longitudinal studies that assessed e-cigarette awareness, 'ever use' or current use, and included subgroup analysis of 1 or more PROGRESS Plus sociodemographic groups. No geographical or time restrictions imposed. Assessment by multiple reviewers, with 17% of full articles screened meeting the selection criteria. DATA EXTRACTION: Data extracted and checked by multiple reviewers, with quality assessed using an adapted tool developed by the Joanna Briggs Institute. DATA SYNTHESIS: Results of narrative synthesis suggest broadly that awareness, 'ever use' and current use of e-cigarettes may be particularly prevalent among older adolescents and younger adults, males, people of white ethnicity and-particularly in the case of awareness and 'ever use'-those of intermediate or high levels of education. In some cases, results also varied within and between countries. CONCLUSIONS: E-cigarette awareness, 'ever use' and current use appear to be patterned by a number of sociodemographic factors which vary between different countries and subnational localities. Care will therefore be required to ensure neither the potential benefits nor the potential risks of e-cigarettes exacerbate existing health inequalities.

What are kids vaping? Results from a national survey of US adolescents.

OBJECTIVE: To examine what substances US youth vape. METHODS: Data come from Monitoring the Future, an annual, nationally representative survey of USA 12th-grade, 10th-grade and 8th-grade students. Respondents reported what substance they vaped the last time they used a vaporiser such as an e-cigarette. RESULTS: Among students who had ever used a vaporiser, 65-66% last used 'just flavouring' in 12th, in 10th and in 8th grade, more than all other responses combined. In all three grades, the percentage using 'just flavouring' was above 57% for males, females, African-Americans, Hispanics, Whites, and students both with and without a parent with a college degree. Nicotine use came in a distant second, at about 20% in 12th and 10th grade and 13% in 8th grade. Taking into account youth who vaped nicotine at last use increases national estimates of tobacco/nicotine prevalence in the past 30 days by 24-38% above and beyond cigarette smoking, which is substantial but far less than estimates that assume all vaporiser users inhale nicotine. CONCLUSIONS: These results challenge the common assumption that all vaporiser users inhale nicotine. They (a) call into question the designation of vaporisers and e-cigarettes as ENDS ('Electronic Nicotine Delivery System'), (b) suggest that the recent rise in adolescent vaporiser use does not necessarily indicate a nicotine epidemic, and (c) indicate that vaporiser users can be candidates for primary prevention programmes. Finally, the results suggest the importance of developing different rationales for the regulation of vaporiser devices as compared to the regulation of substances marketed for vaporiser use.

Electronic cigarette use among US adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014.

BACKGROUND: Electronic cigarette (e-cigarette) use in the USA is increasing. As such, it is critical to understand who uses e-cigarettes, how e-cigarettes are used and what types of products are prevalent. This study assesses patterns of current e-cigarette use among daily and non-daily adult users in the 2013-2014 Population Assessment of Tobacco and Health (PATH) Study. METHODS: We examined the proportion of current adult e-cigarette users (n=3642) reporting infrequent use (use on 'some days' and use on 0-2 of the past 30 days), moderate use (use on 'some days' and use on >2 of the past 30 days) and daily use. We examined demographic characteristics, use of other tobacco products and e-cigarette product characteristics overall and by use category. Adjusted prevalence ratios (aPRs) were calculated using Poisson regression to assess correlates of daily e-cigarette use. RESULTS: Among the 5.5% of adult current e-cigarette users in the PATH Study, 42.2% reported infrequent use, 36.5% reported moderate use and 21.3% reported daily use. Cigarette smokers who quit in the past year were more likely to report daily e-cigarette use, compared with current smokers (aPR=3.21, 95% CI=2.75 to 3.76). Those who reported using rechargeable or refillable devices were more likely to report daily use compared with those who did not use these devices (aPR=1.95, 95% CI=1.44 to 2.65 and aPR=2.10, 95% CI=1.75 to 2.52, respectively). CONCLUSIONS: The majority of e-cigarette users in this study reported less than daily use. Compared with non-daily use, daily use was associated with being a former smoker; however, cross-sectional data limits our ability to establish the temporality or directionality of such associations.

Mining social media data for opinion polarities about electronic cigarettes.

BACKGROUND: There is an ongoing debate about harm and benefit of e-cigarettes, usage of which has rapidly increased in recent years. By separating non-commercial (organic) tweets from commercial tweets, we seek to evaluate the general public's attitudes towards e-cigarettes. METHODS: We collected tweets containing the words 'e-cig', 'e-cigarette', 'e-liquid', 'vape', 'vaping', 'vapor' and 'vaporizer' from 23 July to 14 October 2015 (n=757 167). A multilabel Naïve Bayes model was constructed to classify tweets into 5 polarities (against, support, neutral, commercial, irrelevant). We further analysed the prevalence of e-cigarette tweets, geographic variations in these tweets and the impact of socioeconomic factors on the public attitudes towards e-cigarettes. RESULTS: Opinions from organic tweets about e-cigarettes were mixed (against 17.7%, support 10.8% and neutral 19.4%). The organic-against tweets delivered strong educational information about the risks of e-cigarette use and advocated for the general public, especially youth, to stop vaping. However, the organic-against tweets were outnumbered by commercial tweets and organic-support tweets by a ratio of over 1 to 3. Higher prevalence of organic tweets was associated with states with higher education rates (r=0.60, p<0.0001), higher percentage of black and African-American population (r=0.34, p=0.01), and higher median household income (r=0.33, p=0.02). The support rates for e-cigarettes were associated with states with fewer persons under 18 years old (r=-0.33, p=0.02) and a higher percentage of female population (r=0.3, p=0.02). CONCLUSIONS: The organic-against tweets raised public awareness of potential health risks and could aid in preventing non-smokers, adolescents and young adults from using e-cigarettes. Opinion polarities about e-cigarettes from social networks could be highly influential to the general public, especially youth. Further educational campaigns should include measuring their effectiveness.

E-cigarette use 1†year later in a population-based prospective cohort.

BACKGROUND: Population prevalence estimates of electronic nicotine delivery system (ENDS) use range considerably based on the operational definition of 'use'. Recently, we investigated the utility of 'use frequency' for restricting prevalence estimates to non-experimenters in adult populations. Results suggested that individuals reporting use on ≤5 days in the past 30 were likely to discontinue use, and should be excluded from estimates of population prevalence. OBJECTIVE: This study investigated the predictive validity of ENDS use frequency as a measure for likelihood of continued use, and cigarette smoking abstinence. METHODS: We recontacted smokers and recent quitters who participated in the random digit dial 2014 Minnesota Adult Tobacco Survey. At ∼1 year follow-up, we reassessed ENDS use and cigarette smoking among N=601 respondents. RESULTS: Fewer than half of respondents who reported using ENDSs on 1-5 days in the past 30 at baseline reported any ENDS use 1 year later (27%, 95% CI (18% to 40%)). Conversely, more than half of respondents who reported daily use at baseline also reported subsequent use at follow-up (89%, 95% CI (78% to 100%)). The likelihood of subsequent ENDS use by respondents using ENDSs on more than 5 days but less than daily did not significantly differ from chance (37%, 95% CI (22% to 61%)). CONCLUSIONS: For adult population surveillance surveys, defining current use prevalence as 'any use in the past 30 days' includes many individuals who can be expected to discontinue use within 1 year. Until measures of ENDS use become standardised, researchers should choose definitions carefully because different definitions are likely to yield different results.

E-cigarette use as a predictor of cigarette smoking: results from a 1-year follow-up of a national sample of 12th grade students.

OBJECTIVE: To prospectively examine vaping as a predictor of future cigarette smoking among youth with and without previous cigarette smoking experience. A secondary aim is to investigate whether vaping may desensitise youth to the dangers of smoking. METHODS: Analysis of prospective longitudinal panel data from the nationally representative Monitoring the Future study. The analysis is based on 347 12th grade students who were part of a randomly selected subsample that completed in-school surveys in 2014 and were resurveyed 1-year later. RESULTS: Among youth who had never smoked a cigarette by 12th grade, baseline, recent vapers were more than 4 times (relative risk (RR)=4.78) more likely to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among 12th grade students who had smoked in the past but had not recently smoked at baseline, recent vapers were twice (RR=2.15) as likely to report smoking in the past 12 months at the follow-up. Vaping did not predict cessation of smoking among recent smokers at baseline. Among never-smokers at baseline, recent vapers were more than 4 times (RR=4.73) more likely to move away from the perception of cigarettes as posing a 'great risk' of harm, a finding consistent with a desensitisation process. CONCLUSIONS: These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Vaping as a risk factor for future smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes.

Electronic cigarette initiation among minority youth in the United States.

BACKGROUND: Electronic cigarettes (e-cigarette) use among youth is a pressing public health issue, with prevalence of use surpassing that of tobacco cigarettes. While research concerning e-cigarettes has proliferated in recent years, there is a dearth of information regarding those whose first exposure to tobacco products was an e-cigarette. OBJECTIVES: To examine factors associated with e-cigarette initiation among minority youth in the United States. METHODS: Data on minority students in middle and high schools in the United States derived from the 2014 National Youth Tobacco Survey (NYTS) were sampled (weighted N = 27,294,454). We examined e-cigarette initiation among minority youth using logistic regression models to identify related factors. RESULTS: In 2014, 736,158 minority youth were e-cigarette initiators. Odds of e-cigarette initiation was highest among Hispanic youth [adjusted odds ratio (AOR) = 2.70; 95% confidence interval (CI) = 1.60-4.56]. Exposure to e-cigarette advertising (AOR = 1.64; 95% CI = 1.07-2.50), perceptions of little to no harm (AOR = 7.08; 95% CI = 4.03-12.46), and believing e-cigarettes were less addictive than tobacco (AOR = 2.15; 95% CI = 1.52-3.02) were associated with e-cigarette initiation. CONCLUSIONS: Odds of initiating e-cigarette use was highest among Hispanic youth. Among minority youth, e-cigarette initiation was associated with perceptions of harm and addiction potential, as well as exposure to e-cigarette advertising. Therefore, prevention efforts targeting minority youth who are at risk of becoming e-cigarette initiators may benefit by incorporating these factors into prevention campaigns.

[Qualitative analysis among electronic cigarette users: practices, use, representations]. / Étude qualitative auprès des utilisateurs de cigarette électronique : pratiques, usages, représentations.

INTRODUCTION: Electronic cigarettes are smokeless devices that simulate the act of tobacco smoking by spraying an ?e-liquid? and diffusing an aerosol that is inhaled by the user. Although the initial enthusiasm observed in 2012-2013 has tended to flag, electronic cigarettes are now part of the landscape of smokers seeking an alternative to smoking and abstinence. Smoking cessation professionals need to meet a growing demand from smokers and must adopt a clear position in relation to this device. METHODS: The results presented here were derived from a qualitative study conducted with the financial support of the French Directorate of Health, part of the Ministry of Social Affairs and Health from September 2014 to January 2016. RESULTS: The study was based on classical field-work ethnology: observations were made during events involving electronic cigarette users and 25 semi-structured interviews with diverse profiles to clarify a poorly known field. This study contributes to the observation and understanding of an emerging phenomenon, likely to induce a lasting change in our relationship to tobacco. DISCUSSION: The study revealed a wide variety of profiles among smokers interested by electronic cigarettes. Men and women, young and old, or former smokers, adopt various attitudes when trying this device, and their patterns of use often change over the months following initiation.

Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings.

INTRODUCTION: The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. METHODS: Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. RESULTS: Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. CONCLUSIONS: The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction.

Waterpipe tobacco and electronic cigarette use in a southeast London adult sample: a cross-sectional analysis.

BACKGROUND: Waterpipe tobacco and electronic cigarettes (e-cigarettes) share several features: rising popularity, use of product flavourings and concerns about marketing to youth. We sought to compare prevalence and predictors of waterpipe tobacco and e-cigarette use, and explore knowledge of waterpipe tobacco and support for interventions. METHODS: We used convenience sampling methods to conduct a cross-sectional survey among adults in the ethnically diverse southeast London area. Multivariate logistic regression identified predictors of waterpipe and e-cigarette use. Predictor variables were age, gender, ethnicity and current (past 30-day) cigarette use. RESULTS: Of 1176 respondents (23.0% aged 25-34 years, 56.0% male, 57.4% white ethnicity and 30.4% current cigarette smokers), 31.0% had tried waterpipe tobacco and 7.4% had tried e-cigarettes. Both products were significantly associated with younger age groups, non-white ethnicities and use of each other. Waterpipe tobacco was independently associated with consumption of cigarettes while e-cigarettes were not. Among those aware of waterpipe, a third answered incorrectly to knowledge questions. Among those self-identified as coming from a traditional waterpipe-using community, two-thirds supported further legislative and health promotion waterpipe interventions. CONCLUSIONS: Waterpipe tobacco was common and more prevalent than e-cigarettes in this population. Interventions to prevent and control waterpipe are unlikely to marginalize traditional waterpipe-using communities.

Electronic cigarettes and adolescents.

Question I see in my office an increased number of adolescents who use electronic cigarettes (e-cigarettes). Should I encourage adolescents to choose e-cigarettes over regular cigarettes if they decide to smoke? Are e-cigarettes less harmful and a potential smoking cessation method for adolescents? Answer While e-cigarettes do not have carcinogenic tobacco, most contain nicotine, which not only leads to addiction, but can also impair brain development and cognitive function in youth. Recent studies have also shown that adolescents who use e-cigarettes are more likely to begin smoking tobacco cigarettes. It is therefore essential that physicians explain to adolescents the risks and health concerns e-cigarettes present, and implement measures to prevent or cease e-cigarette use.