[Applying Problem Behavior Theory to Investigate the Factors Affecting Tobacco Products Use by Students at Eight Universities in the Greater Taipei Area].

BACKGROUND: There is growing concern related to the recent rise in consumption of cigarettes, electronic cigarettes, and heated tobacco products. The government should pay more attention to the use of various tobacco products by university students. PURPOSE: Problem behavior theory was used in this study to explore the factors influencing the use of various tobacco products by university students in the Greater Taipei area. METHODS: In this cross-sectional study, convenience sampling was used to select eight institutions of higher education in the Greater Taipei area. Eight departments recognized by the Ministry of Education were then listed on a table for use in randomizing the selection of third- and fourth-year undergraduate students. A total of 115 participants filled out the questionnaires included in the self-administered online survey. Data analysis was conducted using logistic regression. RESULTS: The prevalence of tobacco-product use in the sample was 5.22%. Logistic regression analysis revealed having parents who smoked (adjusted odds ratio, AOR = 2.05), holding a positive attitude toward their parents' smoking (AOR = 4.23), having peers who smoked (AOR = 4.33), engaging in deviant behavior (AOR = 90.44), and having peers involved in deviant behavior (AOR = 103.99) to be associated with a higher likelihood of engaging in tobacco-product use. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Family, peers and delinquency significantly influence the usage behavior of university students with regard to tobacco products. The government should allocate greater resources for tobacco harm prevention education aimed at the parents of university students. In addition, integrating tobacco harm education into campus curricula, utilizing social media for online digital education, and providing students with counseling and support measures are strategies that may help reduce the tobacco-product use among this vulnerable population.

Cross-Sectional Associations of Multiple Tobacco Product Use with Depressive and Anxiety Symptoms among Young Adult E-Cigarette Users.

BACKGROUND: Tobacco users with mental health conditions are a vulnerable population in tobacco research, yet few studies have evaluated the association of depressive and anxiety symptoms with multiple tobacco product (MTP) use among young adult electronic cigarette (ENDS) users. METHODS: Cross-sectional survey data on U.S. young adult past 30-day ENDS users (N = 2348) were collected via Amazon MTurk from May-July 2019. Binary logistic regressions evaluated the association of tobacco use pattern (exclusive ENDS use, ENDS + one other tobacco product [OTP; dual use], ENDS + two or more OTPs [poly-use]) with depressive (PHQ-9) and anxiety (GAD-7) symptoms. Among MTP users (n = 1736), we evaluated the association of ENDS use relative to OTP use and same-day MTP use with depressive and anxiety symptoms. RESULTS: The sample included 26% exclusive ENDS, 27% dual, and 47% poly-users. We observed a gradient-relationship for depressive and anxiety symptoms: poly-users had greater odds of depressive and anxiety symptoms compared to dual users (aOR = 1.86 [95%CI:1.50-2.30] and aOR = 1.61 [95%CI:1.30-2.01], respectively), and dual users had greater odds of depressive and anxiety symptoms compared to exclusive ENDS users (aOR = 1.42 [95%CI:1.11-1.81] and aOR = 1.56 [95%CI:1.20-2.02], respectively). MTP users who used ENDS more often than OTPs (vs. less often than OTPs) had greater odds of depressive (aOR = 1.38 [95%CI:1.06-1.80]) and anxiety (aOR = 1.37 [95%CI:1.04-1.79]) symptoms. CONCLUSIONS: The majority of young adult past 30-day ENDS users in this sample reported OTP use. Future research on MTP use should distinguish between dual and poly-use. Tobacco prevention efforts for young adults with mental health symptoms are needed.

Longitudinal Patterns of Multiple Tobacco and Nicotine Product Use Among Texas College Students: a Latent Transition Analysis.

Diverse tobacco and nicotine products have altered the terrain of tobacco use behaviors. Limited research has examined contemporary patterns of use among young adults. This study identified tobacco and nicotine product use groups and examined changes in young adults' use patterns, across a 1.5-year period. Participants were 5,482 18-29-year-old students (M age = 20.5, SD = 2.36; 63% female) from 24 Texas colleges who completed a four-wave bi-annual online survey. Latent transition analysis was used to identify groups from 10 items (ever and current use of cigarettes, cigars, smokeless tobacco, e-cigarettes, and hookah) and to examine probabilities of transitioning between groups over four waves. Five groups were identified: Non-users (30%), Poly-experimenters (26%), Hookah experimenters (18%), E-cigarette & hookah experimenters (15%), and Poly-cigarette users (11%). Few students transitioned between groups over time. Poly-cigarette users had the highest average probability of remaining stable over time (1.00), followed by E-cigarette & hookah experimenters (.97), Non-users (.94), Poly-experimenters (.93), and Hookah experimenters (.92). All groups became more stable over time except Hookah experimenters whose members were most likely to transition to Poly-cigarette users or other experimenter groups. The greatest transition was from Poly-experimenters to Poly-cigarette users with probabilities of .10, .08, and .03 for transitioning between waves one and two, two and three, and three and four, respectively. There was substantial poly-use and experimentation, which may explain little movement between groups over the 1.5-year time period and underscores the need for prevention programs targeting multiple product use among college students.

Longitudinal transitions in tobacco use in youth and young adults: A latent transition analysis of the population assessment of tobacco and health study from Wave 1 to 5.

BACKGROUND: Tobacco use by youth and young adults can lead to significant long-term health problems. We aim to understand transitions in tobacco use patterns among these groups and the factors that affect transition patterns. METHODS: Using the five waves of data from the nationally representative Population Assessment of Tobacco and Health (PATH) Study (2013-2019), we conducted latent class analysis and latent transition analysis to understand tobacco use classes and the longitudinal transitions between classes. We also adjusted for covariates, including demographics, individual behaviors, household environment, and psychosocial factors, to capture their effects on class transition probabilities. RESULTS: Three tobacco use behaviors were identified: non-current user (C1), moderate e-cigarette user (C2), and poly-tobacco user (C3). At baseline (Wave 1), 94.4% of participants were classified as C1, 3.2% as C2, and 2.4% as C3, and the distribution shifted towards C2 and C3 over time. Progression to the next class represented the most common transitions (14.1% C2 to C3, 10.7% C1 to C2), while the direct progression from C1 to C3 was rare (0.6%). Being male, White, adult, living in smoking-allowed households, past-year alcohol use, drug use, internalizing problems, and social media follower of tobacco brands were associated with a faster progression to poly-tobacco use. CONCLUSIONS: The transition patterns implied that e-cigarette use might be an intermediate progression from non-current use into poly-tobacco use. Individual behaviors, household environment, and psychosocial factors are associated with elevated risks of progression. The findings may inform tobacco prevention and cessation policies among youth and young adults.

Patterns of oral nicotine pouch use among U.S. adolescents and young adults.

Oral nicotine pouches are gaining popularity, yet national-level research on youth and young adult use is still needed. We examined characteristics of those who use oral nicotine pouches and trends in use over time in a sample of U.S. youth and young adults. Data were obtained from a weekly, national, online, continuous tracking survey of approximately 315 unique participants (aged 15-24) per week. Bivariate analyses were conducted on those surveyed December 2021 to May 2022 (n = 7,832) summarizing demographic and tobacco product use characteristics of those currently using oral nicotine pouches, those who had ever used oral nicotine pouches, but not currently, and those who never used pouches. From December 2021 to May 2022, 16% of participants ever used nicotine pouches and 12% currently used the product. Participants who currently used oral nicotine pouches were more likely to report being aged 21+, male, and lower income. Seventy-three percent of those who currently used pouches and 33% of those who ever, but not currently, used pouches reported current cigarette smoking. Results suggest that many young people who smoke cigarettes are concurrently using oral nicotine pouches. We also examined current and ever use in respondents surveyed between September 2020 and May 2022 to assess trends over the two-year period (n = 25,944) and findings indicate stable oral nicotine product use rates over time among adolescents and young adults. Appropriate regulation is needed so nicotine naïve individuals do not initiate use and those currently using tobacco do not use oral nicotine pouches concurrently with other products.

Multiple Tobacco Product Use among Adolescents with Asthma in Korea.

Few studies have examined the use of multiple tobacco products among adolescents with asthma. The purpose of this study was to examine multiple tobacco product use and smoking behaviors. In this study, data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) were used, and 57,303 samples from 400 middle schools and 400 high schools in Korea were classified as study participants. Statistical analysis was performed with a complex sample design, using frequency analysis, chi-square test, and multiple logistic regression analysis. Adolescents with asthma had a higher current smoking rate for combustible cigarettes (CC), e-cigarettes (EC), and heated tobacco products (HTPs) than those without asthma (p < 0.001). The rates of dual use (using two types of tobacco; CC + EC or CC + HTPs or EC + HTPs; OR = 2.62, 95% CI: 1.626−4.240, R2 = 26.8%) and triple use (using three types of tobacco; CC + EC + HTPs; OR = 2.61, 95% CI: 1.678−4.065, R2 = 34.9%) were higher in adolescents with asthma than those without asthma, after adjusting for confounders. The smoking rate of new types of tobacco among adolescents with asthma is on the rise. Therefore, the calculation of basic data related to new tobacco smoking among adolescents is essential for establishing a continuous monitoring system to alleviate the burden of disease on national health.

Substitution of flavored cigarillos with menthol cigarettes among young adults in the U.S.

BACKGROUND: Young adult cigarillo users often cite flavor as a primary reason for initiating and sustaining product use and are more likely to concurrently use other tobacco products such as menthol cigarettes. This study examines substitution with menthol cigarettes among cigarillo users facing a hypothetical ban on flavored cigarillos. METHODS: Current young adult (21-28 years) cigarillo users were recruited from October 2020 to April 2021 for an online survey about cigarillo and other tobacco use behaviors. Participants (n = 500) self-reported past or current menthol cigarette experience, and if they would switch to menthol cigarettes if they could not get flavored cigarillos. Logistic regression was used to test differences in switching behaviors by level of experience with menthol cigarettes. RESULTS: Most young adult cigarillo users (76.8 %) had ever used a menthol cigarette and 46.6 % reported current use of menthol cigarettes. No participant who had never used menthol cigarettes reported they would switch to menthol cigarettes. Current users were 4.2 times as likely to say they would switch after controlling for demographic characteristics and nicotine dependence. CONCLUSION: Most young adult cigarillo users reported they would not switch to menthol cigarettes if flavored cigarillos became unavailable. However, participants who currently use or have used menthol cigarettes were more likely to report their intention to switch products than those who had never used menthol cigarettes. There may be a subsequent increase in menthol cigarette use among past menthol cigarette users if policies restricting flavored tobacco products exclude menthol cigarettes, diluting these policies' intended population health impact.

Risk factors for multiple tobacco product use among high school youth.

PURPOSE: To examine how youth multiple tobacco product (MTP) users differ relative to non-users and to single-product users on risk factors at multiple levels of influence. METHODS: We analyzed data on high school students from the North Carolina Youth Tobacco Survey, 2015 (n = 2922). Single- and MTP use were defined as use of one, or two or more tobacco products in the past month, respectively. Multinomial regressions estimated the association between risk factors and MTP use compared to single-product use and non-use of tobacco. Risk factors included intra-personal (e.g., harm perceptions), and interpersonal (e.g., household, peer tobacco use, secondhand smoke or vapor, and advertising) factors. RESULTS: Of students, 12% and 13% were single product and MTP users, respectively. Many differences emerged between MTP users and non-tobacco users, with MTP users showing lower harm perceptions, higher perceived social benefits of smoking, significantly higher relative risk of having friends who use tobacco (RRR = 4.79, 95% CI 3.42, 6.70), of exposure to secondhand e-cigarette vapor (RRR = 1.35, 95% CI 1.23, 1.48), and of being receptive to tobacco marketing (RRR = 4.01, 95% CI 2.87, 5.61). Fewer differences emerged between MTP and single product users with MTP users having significantly higher relative risk of having friends who use tobacco (RRR = 2.31 95% CI 1.73, 3.07), of exposure to secondhand vapor (RRR = 1.10, 95% CI 1.02, 1.18), and of being receptive to tobacco marketing (RRR = 1.71, 95% CI 1.17, 2.50). CONCLUSIONS: Efforts that target multiple tobacco product use should increase youth tobacco-related harm perceptions, and protect youth from social, peer, and industry influences.

Tobacco product transition patterns in rural and urban cohorts: Where do dual users go?

INTRODUCTION: Understanding diverse tobacco product consumption represents a crucial area for tobacco regulatory science. With the increase in dual/poly use of tobacco products, transition patterns among exclusive and dual users are of considerable interest. We describe transition patterns of dual users over 18 months. METHODS: A cohort of 145 adults in urban and rural Ohio who reported dual tobacco product use at least some days/week was enrolled during 2014-17. Participants completed follow-up interviews every six months where they were classified into one of five categories: 1) exclusive combustible, 2) exclusive smokeless, 3) exclusive e-cigarette, 4) dual (at least 2 of the previous 3 categories), and 5) less than some days/week. Participants categorized as exclusive and dual (1-4) used their products at least some days per week. Separately within the rural and urban cohorts, 6, 12, and 18 month transition probabilities between the categories were estimated. RESULTS: The probability of remaining a dual user after 6 months is 43% in the rural and 37% in the urban cohort. The decline continues through 18 months with 24% of rural and 22% of urban dual users remaining in the category. The probability of a dual user consuming combustibles and e-cigarettes transitioning to exclusive combustible use in 6 months is over 50% in both the rural and urban cohorts. CONCLUSIONS: Dual use is an unstable state with users being more likely to transition to exclusive combustible use than to remain in the dual use category. Transitions are similar in the rural and urban cohorts.