Psychological Distress and Cannabis Vaping Among U.S. Adolescents.

INTRODUCTION: Cannabis vaping has become increasingly popular among adolescents in recent years. However, research examining mental health determinants of cannabis vaping is scant. This study investigated the relationship between psychological distress and cannabis vaping among a nationally representative sample of U.S. adolescents. METHODS: Data are from the cross-sectional 2022 National Youth Tobacco Survey, restricted to adolescents ages 11-18 (n=22,202). Psychological distress was categorized as normal, mild, moderate, and severe according to the Patient Health Questionnaire for Depression and Anxiety-4. Cannabis vaping was defined as any use in the past 30 days. To estimate the association between psychological distress and cannabis vaping, logistic regression was performed adjusted for age, biological sex, race/ethnicity, sexual orientation, school grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use. Analyses were conducted in 2023. RESULTS: Nearly 8% of adolescents vaped cannabis in the past 30 days, and 25.6% reported moderate or severe psychological distress. Mild, moderate, and severe psychological distress were associated with cannabis vaping in the unadjusted model. In the adjusted model, the odds of cannabis vaping were higher among adolescents who had severe psychological distress (OR: 1.46, 95% CI: 1.09-1.96), compared to adolescents with no distress. Older age, poor grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use were also associated with cannabis vaping. CONCLUSIONS: Severe psychological distress was associated with past 30-day cannabis vaping among U.S. adolescents. Adolescents experiencing psychological distress need to be screened for cannabis vaping to help prevent and reduce use and promote mental health.

Differences in health care provider screening for tobacco use among youth in the United States: The National Youth Tobacco Survey, 2021.

OBJECTIVE: Health care providers (HCP) are encouraged to screen youth for tobacco product use as a key step in preventing such use and associated health outcomes. However, recent data examining differences in HCP tobacco screening by sociodemographic characteristics and tobacco use is scant. METHODS: Data from the 2021 National Youth Tobacco Survey (N = 14,685) were analyzed. Three types of HCP screening were examined: no screening, any e-cigarette use (e-cigarette only, e-cigarette and other tobacco), and non-e-cigarette tobacco product use. Differences by HCP screening were examined using multinomial logistic regression adjusted for age, sex, gender identity, sexual orientation, race/ethnicity, and tobacco use (non-current, sole, dual/poly). RESULTS: Among the sample, 42.8% were screened for any tobacco use, with 30.6% screened for any e-cigarette use and 12.2% for non-e-cigarette tobacco product use only. Youth who were older (vs. younger) (OR = 5.98, 95% CI: 4.78-7.49) and gay/lesbian (vs. heterosexual) (OR = 1.47, 95% CI: 1.02-2.12) were more likely to be screened for e-cigarette use. Youth who were non-Hispanic Black (vs. non-Hispanic White) were less likely to be screened for e-cigarette use (OR = 0.53, 95% CI: 0.42-0.67) and more likely to be screened for non-e-cigarette tobacco use (OR = 1.34, 95% CI: 1.10-1.63). Current sole tobacco use (vs. non-current use) and dual/poly tobacco use (vs. non-current use) increased the likelihood for HCP screening for e-cigarette use. CONCLUSIONS: The majority of U.S. youth continue to not be screened for tobacco use by their HCP. Evidence of disparities in tobacco use screening suggest the need for policies and training that promote equity in screening.

Differences in health care provider advice on abstaining from tobacco use: Findings from the 2020 National Youth Tobacco Survey.

BACKGROUND: Health care providers' (HCP) advice on tobacco prevention and cessation is critical in addressing the tobacco use epidemic among adolescents. However, examination of whether receiving advice from HCPs differs by adolescent sociodemographic characteristics and tobacco use is limited. METHODS: HCP advice to abstain from using tobacco was examined using the 2020 National Youth Tobacco Survey (N = 12,483). Sociodemographic (age, sex, sexual orientation, race/ethnicity, and region) and tobacco use (non-current, sole, dual/poly) differences by HCP advice were evaluated using adjusted logistic regression models. RESULTS: Among the sample, 37.26% of adolescents received HCP advice to abstain from using tobacco products, and 31.35% received HCP advice to abstain from using e-cigarettes specifically. Adolescents who were non-Hispanic Black (vs. non-Hispanic White) were more likely not to receive HCP advice to abstain from all tobacco products (OR = 1.31, 95% CI: 1.08-1.59). Adolescents who were non-Hispanic Black (vs. non-Hispanic White) (OR = 1.41, 95% CI: 1.16-1.73) or sexual minority (vs. heterosexual) (OR = 1.16, 95% CI: 1.02-1.33) were more likely not to receive HCP advice to abstain from e-cigarettes. Adolescents who were aged 16-18 (vs. aged 9-12) (OR = 0.68, 95% CI: 0.56-0.83) or currently use dual/poly tobacco products (vs. adolescents who do not currently use tobacco) (OR = 0.56, 95% CI: 0.43-0.74) were more likely to receive HCP advice to abstain from using e-cigarettes). CONCLUSIONS: Many U.S. adolescents do not receive HCP advice to abstain from using tobacco. HCPs should increase tobacco prevention and cessation advice across adolescent groups, particularly racial/ethnic and sexual minorities. HCP training and public health policies that improve delivery of e-cigarette advice to adolescents are essential.

Harm perceptions of secondhand e-cigarette aerosol among youth in the United States.

E-cigarette use among youth remains a public health concern. Although extant literature has examined the perceived harms of cigarette use and secondhand smoke, perceptions of harms associated with secondhand e-cigarette aerosol (SHA) are not well understood. Therefore, we used data from the 2020 U.S. National Youth Tobacco Survey (n = 13,292) in which participants indicated whether SHA caused no harm, little harm, some harm, or a lot of harm. We dichotomized SHA harm perceptions as harmless vs harmful. We included sociodemographics (i.e., age, sex, race/ethnicity, sexual orientation, urbanicity), e-cigarette use characteristics, and SHA exposure as covariates and estimated associations between SHA harm perceptions and each covariate using adjusted logistic regression. Most youth perceived SHA as harmful (87.9 %) compared to harmless (12.1 %). Older youth (vs younger youth) had higher odds of perceiving SHA as harmless, whereas male (vs female) youth had 49 % higher odds (95 % CI: 1.29-1.72) of perceiving SHA as harmless. As the number of days of e-cigarette use in the past 30 days increased (vs non-users), odds of perceiving SHA as harmless increased. Youth exposed to SHA (vs no exposure) in the past 30 days had 35 % higher odds of perceiving SHA as harmless (95 % CI: 1.16-1.57). To conclude, youth SHA harm perceptions varied overall and by sociodemographic characteristics, e-cigarette use, and SHA exposure. Educational campaigns to inform youth of the health risks associated with e-cigarettes and SHA are needed to reduce overall nicotine intake and disparities in nicotine exposure.

Readability of online e-cigarette cessation information.

INTRODUCTION: Given the growing awareness of the health risks associated with e-cigarettes, many users will access information about how to effectively quit using e-cigarettes, and the internet likely will be a popular source of information. However, little is known about the readability of online e-cigarette cessation information. Therefore, the goal of the current study was to assess the readability of webpage information about e-cigarette cessation. METHODS: A search of webpages was conducted using the following search terms: vaping addiction, quit vaping, quit Juul, stop vaping, stop Juul, and vaping cessation. The 464 webpages identified were coded for target audience, message valence, and source, and then assessed for reading level with the Flesch-Kincaid Grade Level assessment. RESULTS: On average, webpage content was written at a 7th grade reading level (Flesch-Kincaid Grade Level Mean=7.34, SD=2.22) and less than 25% of webpages met readability guidelines (i.e. ≤6th grade reading level). There were no differences in readability by target audience, message valence, or webpage source. CONCLUSIONS: The results suggest that most online content related to e-cigarette cessation is not written at a level that is easily understood by general audiences. Thus, tobacco control advocates should assess the reading level of their messaging to ensure wide accessibility of information.

Tobacco Use Status and Temptation to Try E-Cigarettes among a Sample of Appalachian Youth.

E-cigarettes are commonly used tobacco products among youth populations, including Appalachian youth. However, knowledge of the extent to which tobacco use status relates to temptation to try e-cigarettes is limited. Data from the Youth Appalachian Tobacco Study (n = 1047) were used. Temptation to try e-cigarettes was derived from a 12-item situational inventory. Tobacco use status was defined as never, ever non-e-cigarette, and ever e-cigarette use. A factorial ANOVA was used to estimate the adjusted association between tobacco use status and the e-cigarette use temptation scale. Two-way interaction terms between tobacco use status and gender, and tobacco use status and race/ethnicity, were plotted to depict effect modification. Approximately 10% of youth were ever non-e-cigarette users and 24% were ever e-cigarette users. Never and ever non-e-cigarette user middle schoolers had higher temptation to try e-cigarettes than their high school counterparts. The same relationship was found among never and ever e-cigarette users living in households with tobacco users. The ANOVA results suggest a positive, monotonic relationship between tobacco use status and temptation to try e-cigarettes, and that the adjusted group means differ by gender and race/ethnicity. The findings can inform tobacco prevention interventions for youth at higher risk for e-cigarette use, especially youth who have not yet tried e-cigarettes.