Age of e-cigarette initiation in USA young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study (2013-2017).

INTRODUCTION: There is a lack of research prospectively estimating the age of e-cigarette initiation in U.S. young adults. METHODS: Secondary analysis of PATH young adults across 2013-2017 (waves 1-4) were conducted. We prospectively estimated age of initiation of: ever, past 30-day, and fairly regular e-cigarette use using weighted interval-censoring survival analyses. Interval-censoring Cox proportional hazard models adjusting for sex, race/ethnicity, and previous use of six other tobacco products (cigarettes, traditional cigars, filtered cigars, cigarillos, hookah, and smokeless tobacco) were fitted for each of the three e-cigarette initiation outcomes. RESULTS: Among never e-cigarette users, by age 21, 16.8% reported ever use, 7.2% reported past 30-day use, and 2.3% reported fairly regular e-cigarette use. Males had increased risk of initiating ever, past 30-day, and fairly regular e-cigarette use at earlier ages compared to females. Hispanic young adults had increased risk of initiating ever and past 30-day e-cigarette use at earlier ages compared to Non-Hispanic White young adults. Previous use of other tobacco products before e-cigarette initiation increased the risk of an earlier age of e-cigarette initiation. CONCLUSION: Prevention and education campaigns should focus on young adults in order to alleviate the public health burden of initiating e-cigarette use at earlier ages.

Assessing Electronic Nicotine Delivery Systems Use at NCI-Designated Cancer Centers in the Cancer Moonshot-funded Cancer Center Cessation Initiative.

Assessing tobacco product use and delivering tobacco dependence treatment is an essential part of cancer care; however, little is known about electronic nicotine delivery systems (ENDS) or e-cigarette use assessment in cancer treatment settings. Given the importance of tailoring tobacco treatment, it is critical to understand how ENDS use is assessed in the electronic health record (EHR) in cancer care settings. Two questionnaires were completed by tobacco treatment program leads at 42 NCI-Designated Cancer Centers in the Cancer Center Cessation Initiative (January 1 to June 30 and July 1 to December 31, 2019). Items assessed how often smoking status and ENDS use were recorded in the EHR. An open-ended item recorded the text and response categories of each center's ENDS assessment question. All 42 centers assessed smoking status at both time periods. Twenty-five centers (59.5%) assessed ENDS use in the first half of 2019, increasing to 30 (71.4%) in the last half of 2019. By the end of 2019, 17 centers assessed smoking status at every patient visit while six assessed ENDS use at every visit. A checkbox/drop-down menu rather than scripted text was used at 30 centers (73.2%) for assessing smoking status and at 18 centers (42.9%) for assessing ENDS use. Our findings underscore the gap in systematic ENDS use screening in cancer treatment settings. Requiring ENDS use measures in the EHR as part of quality measures and providing scripted text scripts to providers may increase rates of ENDS use assessment at more cancer centers. PREVENTION RELEVANCE: This study identifies a gap in the systematic assessment of ENDS use among patients seen at 42 NCI-Designated cancer centers. Requiring the systematic assessment of both ENDS use and use of other tobacco products can inform evidence-based treatment of tobacco dependence and lead to improved cancer treatment outcomes.

Spirituality, Ethnic Identity, and Substance Use among American Indian/Alaska Native Adolescents in California.

Background. American Indian/Alaska Native (AIAN) adolescents have a higher prevalence of commercial tobacco, alcohol, and marijuana use than other racial/ethnic groups in the United States. It is unclear whether cultural factors such as ethnic identity, spirituality, and ceremonial use of traditional tobacco are associated with substance use, especially use of emerging tobacco products such as electronic cigarettes, among AIAN adolescents. Methods. This study investigated the association between hypothesized cultural protective factors (ethnic identity, spirituality, and ceremonial use of traditional tobacco) and past-month use of commercial cigarettes, e-cigarettes, marijuana, blunts, and alcohol among 156 AIAN adolescents in California (mean age = 15.3 years, 55% female). Adolescents from six AIAN schools and afterschool programs completed paper-and-pencil surveys. We used Logistic regression analyses to identify the significant cultural correlates of past-month substance use, controlling for demographic covariates. Results. As hypothesized, strong ethnic identity was protective against cigarette, marijuana, and alcohol use. However, it was not protective against e-cigarette or blunt use. Spirituality was associated with an increased risk of cigarette and marijuana use. Previous ceremonial use of traditional tobacco was not associated with past-month recreational substance use. Conclusions. Results indicate that the associations between cultural factors and substance use vary across substances. Future research should identify cultural factors that protect AIAN adolescents against use of newer products such as e-cigarettes and blunts.

E-Cigarettes and Vaping Implicated in Recent Cases of Severe Lung Disease.

The CDC and FDA are partnering with states to investigate reports.

Analysis of the geographical accessibility of vape shops in the vicinity of Quebec's secondary and college educational institutions. / Analyse de l'accessibilité géographique aux commerces spécialisés en produits de vapotage autour des établissements d'enseignement secondaire et collégial du Québec.

INTRODUCTION: significant proportion of secondary school students and young adults in Quebec have experimented with electronic cigarettes (e-cigarettes). Both personal and environmental factors have been associated with the use of vaping products by youth. Geographical accessibility to the points of sale of these products may be one of these factors. The purpose of this study is to develop a profile of the spatial distribution of stores specializing in the sale of vaping products (vape shops) in the vicinity of secondary schools, colleges and CEGEPs in the province of Quebec. METHODS: We calculated the accessibility of businesses to account for geographical exposure. Analyses were conducted to provide a snapshot of the situation in Quebec and to identify associations between the characteristics of educational institutions and geographical accessibility to vape shops. RESULTS: A total of 299 vape shops were identified. Colleges are closer to a vape shop (median distance: 1.2 km) than are secondary schools (median distance: 2.3 km). Large private colleges located in urban areas are closer to specialized vape shops. Medium or large private secondary schools located in urban and more advantaged areas are also closer to a specialized vape shop. CONCLUSION: This study is a step in developing an understanding of the location of vaping product shops and their geographical accessibility to young people. Important to consider is the geographical accessibility of young people to non-specialized shops that also sell e-cigarettes and then any potential connections between geographical accessibility to such non-specialized shops and the use of vaping products by young people.

Product attributes important to US adult consumers' use of electronic nicotine delivery systems: a discrete choice experiment.

OBJECTIVE: To understand the importance of electronic nicotine delivery systems (ENDS) product attributes to adult consumers in the USA by age and gender. DESIGN: Cross-sectional survey with a discrete choice experiment (best-worst, case 2, scaling) of 19 choice tasks in which participants answered what would make them most want to use and least want to use an ENDS product. SETTING AND PARTICIPANTS: A national sample of adults (aged 18+ years) in the USA who had tried an ENDS product at least once. MEASURES: We included 9 ENDS attributes with levels that varied across 19 choice tasks. We performed a multinomial logistic regression to obtain overall importance scores, attribute-level part-worth utilities and most important attribute. RESULTS: Of 660 participants, 81% were white, 51% women and 37% had at least a 4-year college degree with an average age of 42.0 years (SD ±19.4). The attributes had the following importance: harms of use 17.6%; general effects 14.1%; cessation aid 12.6%; purchase price 12.1%; monthly cost 12.0%; nicotine content 11.4%; flavour availability 8.4%; device design 7.2%; modifiability 4.6%. Harms of use was the most important attribute for all ages and genders (p<0.05); variation in other important attributes existed by age though not by gender. CONCLUSION: This study identified the importance of nine ENDS attributes. Perceived harms of use of ENDS use appeared most important, and modifiability was least important. Variation by consumer group existed, which may allow for targeted interventions to modify ENDS use.

Regulating E-cigarettes in India: A conundrum for the global giant in tobacco production.

Electronic cigarettes which are termed as e-cigarettes, e-cigs or e-vaporizers are used by the people for creating the inhalable aerosol which carries nicotine in it. Also, commonly referred as vaping. E-cigarettes are used as an alternative to the regular cigarettes and aids in the cessation of smoking. However, there has been tough strife and debate regarding e-cigarettes that are accompanied in the media stories which bring different opinions among consumers, experts as well as regulators who are involved in making decisions from no regulation to regulating e-cigarettes to banning of e-cigarettes which will bring direct impact on public health. In this article, an overview about the controversy of e-cigarettes with respect to the device, its market, regulation norms of e-cigarettes at different platforms and amidst the debate over e-cigarettes banning in India has been portrayed. It is surveyed that India being a hub of around 110 million tobacco smokers and a global giant in tobacco production, where the Indian government is planning to bring a complete ban over e-cigarettes throughout the country propels an elementary question of banning safer alternatives and not regular cigarettes which makes no sense from the point of banning e-cigarettes until or unless regular cigarettes are banned. Varying point of views from experts, scientists, users with respect to e-cigarettes has been addressed which shares a mix opinion with the supporters promoting ban as well as the antagonist with the concept of regulating the e-cigarettes in India.

Youth access to JUUL online: eBay sales of JUUL prior to and following FDA action.

BACKGROUND: The novel e-cigarette product JUUL has experienced rapid market growth. The online auction site eBay has been mentioned as a source of JUUL access for youth, and the US Food and Drug Administration (FDA) notified eBay to remove JUUL listings in April 2018. We sought to characterise the sale of JUUL products on eBay prior to the FDA's request, document the impact of this request and explore ways in which eBay vendors bypassed this effort. METHODS: eBay was searched for JUUL-branded products sold by US vendors in March 2018, yielding a sample of 197 listings for devices and/or pods. Each listing was coded for product, listing and youth access content. Following FDA action, each listing was revisited to determine its status, and each vendor's page was searched for JUUL and other vaping content. Data were analysed using descriptive statistics. RESULTS: Of 197 eBay listings, 189 were for JUUL kits and 13 were for pods. Prices were on average higher than those on the official JUUL store, and language about age restrictions was rare. Following FDA contact, most listings were no longer active. However, 3.4% of these vendors still sold JUUL devices or pods and 15.5% were selling other vaporisers or nicotine products. CONCLUSIONS: Online platforms may lack the will or expertise to effectively monitor content for tobacco products, while vendors quickly adapt to minor changes with simple strategies such as spelling variations. Accurate identification of online e-cigarette vendors is essential to the enforcement of policy and may benefit from cross-sector partnerships.