Reactions to a Hypothetical Ban of Open-System Electronic Cigarettes Among People Who Currently Use Electronic Cigarettes.

INTRODUCTION: Policies limiting electronic cigarette (ECIG) device and liquid characteristics have been considered to prevent dependence potential and youth product appeal. "Open-system" ECIGs allow people to adjust device and liquid characteristics, which may undermine these policies. This study examined anticipated reactions to a policy prohibiting the sale of open-system ECIG devices in the United States using concept mapping. METHODS: In 2020, adults who reported ECIG use in the past 30 days (n = 70; 45.1% women; mean age = 33.0, SD = 10.6) recruited from a research registry of individuals from across the United States provided statements into a shared list that completed a prompt: "If open-system vaping devices were no longer sold in the US and only closed-system vaping devices were available, what is a specific reaction or response you would have?" at a study website. Participants rated statements (1-7) on how true the statements were for them. Multidimensional scaling and hierarchical cluster analyses were used to identify thematic clusters. Mean ratings of statements were calculated and compared based on the type of ECIG used and current cigarette smoking status. RESULTS: Participants generated 85 unique statements. The analysis identified eight themes that were organized into two broad groups. The first group of five clusters described behavioral responses to the hypothetical policy (Loopholes, Switch to Closed-System ECIGs, Legal Approaches to Use Open-System ECIGs, ECIG Use Cessation, Switch to non-ECIG Products). The second group of three clusters described psychological responses to the hypothetical policy (Closed-System ECIG Cons, Psychological Responses, Policy Outcome Concerns). CONCLUSIONS: While a ban on open-system ECIG devices may have positive impacts on public health, policy loopholes, and consumer behaviors may undermine the policy. Efforts to support policy enforcement could increase policy effectiveness. IMPLICATIONS: Open-system electronic cigarettes (ECIGs) that allow people who use ECIGs to modify ECIG device and liquid characteristics may limit the effectiveness of policies that establish product standards which attempt to limit nicotine delivery and flavor content in ECIG liquids. This study identified predicted reactions to a hypothetical policy prohibiting the sale of open-system ECIGs in the United States. Results suggest that people who use ECIGs may view a policy prohibiting open-system ECIGs unfavorably, but would be willing to use closed-system ECIGs. However, many ECIG users may attempt to find loopholes in the policy or alternative sources to purchase open-system ECIGs if open-systems were banned. Future research should identify strategies for tobacco regulatory policy enforcement to increase effectiveness.

Impact of Smoking Cessation Motivations and Barriers on Quit Intentions Following a Hypothetical Flavor Ban Among African American/Black Individuals Who Use Menthol Cigarettes: A Mixed-Methods Study.

INTRODUCTION: The Food and Drug Administration (FDA) has proposed banning cigarettes and cigars with characterizing flavors-products used disproportionately by African American/black (AA/B) individuals. Little is known about how AA/B individuals who smoke menthol cigarettes will respond to flavor bans or how to amplify the intended benefits. This study explored predictors of quit intentions following a hypothetical flavor ban and further probed anticipated ban-related responses. AIMS AND METHODS: We recruited 213 AA/B individuals who use menthol cigarettes from Richmond, VA (September 2021-August 2022) for a mixed-methods study. Participants rated seven motivations for quitting and six barriers to quitting (Not a motivation or challenge[1]-Major motivation or challenge[4]), then reported how likely they were to quit smoking if characterizing flavors were banned in cigarettes and cigars. A subsample of 31 participants completed semi-structured interviews to further explore reactions to flavor restriction policies. RESULTS: Multivariable linear regressions suggested that participants who were more motivated to quit smoking because of "information about health hazards" and the "cost of cigarettes" reported higher quit intentions following a hypothetical menthol ban (p < .05). Additionally, those with cessation-related weight concerns reported lower post-ban quit intentions (p < .05). Interview themes highlighted smoking for stress reduction, harm/addiction perceptions of flavored tobacco products, trusted sources of tobacco-related information (including testimonials from people who formerly smoked), potential ban responses, and varying experiences with cessation strategies. CONCLUSIONS: Culturally specific cessation strategies that emphasize the health-related benefits of quitting, particularly those featuring the experiences of people who formerly smoked, may help AA/B individuals who smoke menthol cigarettes quit following a menthol ban. IMPLICATIONS: For the FDA's proposed bans on characterizing flavors in cigarettes and cigars to advance racial health equity, they must maximize cessation among African American/black (AA/B) individuals who use menthol cigarettes. This work suggests information on the health hazards and costs of smoking, as well as concerns over gaining weight, were predictors of quit intentions in a hypothetical flavor ban. Qualitative data suggest messaging highlighting the experiences of individuals who successfully quit may constitute an effective communication strategy. These insights can be used in the development of culturally specific cessation strategies for AA/B individuals who smoke menthol cigarettes.

Exploring Young Adults' Beliefs About Cigar Smoking by Susceptibility: A Belief Elicitation Study.

INTRODUCTION: Young adults are at risk for cigar smoking, which is associated with cancers and pulmonary and cardiovascular diseases. Little is known about young adults' beliefs about smoking cigarillos, little filtered cigars, and large cigars, and how these beliefs may vary across cigar types and by cigar susceptibility. AIMS AND METHODS: The larger study surveyed a U.S. sample of young adults (18-30 years old) who never used tobacco products (n = 948) through Qualtrics online panel services in August 2021-January 2022. We assessed participants' susceptibility to using different cigar types. Participants were randomly assigned to open-ended questions about one of the three cigar types to elicit behavioral, normative, and control beliefs. We conducted thematic analysis to code emergent themes within each belief and examined the frequency of reported themes at the intersection of cigar type and cigar susceptibility. RESULTS: Cigar susceptible participants reported positive behavioral beliefs (eg, anticipated relaxation, mood regulation, being cool), friends as supportive referents, and easy-to-smoke control beliefs (eg, high accessibility, low cost) more frequently than non-susceptible participants. Varied frequency by cigar type also emerged. For example, cigarillo and little filtered cigar features were mentioned more frequently as easy-to-smoke control beliefs, while low accessibility was reported more frequently as a hard-to-smoke control belief for large cigars. CONCLUSIONS: Findings identify salient beliefs about cigarillo, little filtered cigar, and large cigar smoking among young adult tobacco never-users. Future research should investigate the potential importance of these beliefs in cigar smoking susceptibility and initiation among young adults, and their potential utility in prevention research. IMPLICATIONS: This thematic analysis identified salient beliefs about cigarillos, little filtered cigars, and large cigars among a U.S. young adult sample, and differentiated emergent beliefs by cigar susceptibility status and by cigar type. Given the lack of cigar smoking prevention media campaigns, identifying these beliefs is the one of the first steps in developing effective cigar smoking prevention strategies. Future quantitative studies are needed to confirm the relationships between these beliefs and smoking initiation of each cigar type to further inform the types of beliefs to be targeted in strategic communication and help prevent cigar smoking initiation among susceptible young adults.

Nicotine Dependence among Current Cigarette Smokers Who Use E-Cigarettes and Cannabis.

BACKGROUND: Co-use of tobacco and cannabis and dual use of cigarettes and e-cigarettes are very common among young adults. However, it is unclear whether co-use of cigarettes, e-cigarettes, and/or cannabis is associated with higher levels of nicotine dependence than cigarette-only use. We investigated the relationship between cigarette/nicotine dependence and co-use of tobacco and cannabis among 4 groups of cigarette smokers aged 18-35: cigarette-only smokers, cigarette-e-cigarette (CIG-ECIG) co-users, cigarette-cannabis (CIG-CAN) co-users, and cigarette-e-cigarette-cannabis (CIG-ECIG-CAN) co-users. METHODS: Data were from a 2018 cross-sectional survey based on a national convenience sample of smokers aged 18-35 (n = 315). Cigarette/nicotine dependence was measured by the Fagerstrom Test of Nicotine Dependence (FTND) and e-cigarette dependence was measured by the Penn State E-cigarette Dependence Index. Bivariate analyses examined sociodemographic and tobacco/other substance use characteristics by co-use status and multivariable linear regression assessed the relationship between co-use and nicotine dependence. RESULTS: In the sample, 27.6% were cigarette-only smokers, 24.8% were CIG-ECIG, 27.6% were CIG-CAN, and 20.0% were CIG-ECIG-CAN co-users. Significant differences were observed in sociodemographic and tobacco/other substance use characteristics by co-use status. E-cigarette co-users had low e-cigarette dependence, but moderate FTND scores. In adjusted analyses, only CIG-ECIG co-use was associated with higher FTND scores compared to cigarette-only smoking. However, CIG-ECIG and CIG-ECIG-CAN co-use were associated with higher FTND scores compared to CIG-CAN co-use. CONCLUSIONS: Co-use of cigarettes and e-cigarettes was associated with greater nicotine dependence among smokers aged 18-35. Additional research is needed to understand the underlying mechanisms of these relationships and inform prevention efforts.

Electronic Cigarette Users' Reactions and Responses to a Hypothetical Nicotine Concentration Reduction in Electronic Cigarette Liquids.

Background: Regulations limiting nicotine in electronic cigarettes (e-cigarettes) have been proposed or implemented. Little is known about e-cigarette users' reactions to reducing e-cigarette liquid nicotine concentration. Methods: We used concept mapping to describe e-cigarette users' reactions to a 50% reduction in the nicotine concentration of their e-cigarette liquids. In 2019, current e-cigarette users who used e-cigarette liquid with greater than 0 mg/ml nicotine concentration completed an online study. Participants (n = 71, mean age = 34.9 (SD = 11.0), 50.7% women), brainstormed statements completing a prompt: "If the e-liquid that I use now in my e-cigarette/vaping device was only available in half the nicotine concentration or amount that I use now, a specific action I would take or a specific reaction I would have is…", Participants then sorted a final list of 67 statements into piles of similar content and rated statements on how true the statements would be for them. Multidimensional scaling and hierarchical cluster analyses identified thematic clusters. Results: Eight clusters were identified: (1) Replacement Product Seeking, (2) Mental Preparations and Expectations, (3) Use the New Liquid, (4) Information Seeking, (5) Compensation Behaviors, (6) Opportunity for E-Cigarette Reduction, (7) Physical and Psychological Effects, and (8) Replacement with non-E-Cigarette Products and Behaviors. Cluster ratings suggested many participants would search for other e-cigarette products/liquids to replace their current liquids, but using other tobacco products (e.g., cigarettes) may be less likely. Conclusions: If nicotine concentrations were decreased in e-cigarette liquids, e-cigarette users may attempt to purchase different e-cigarette products or modify their products to achieve desired effects.

Centering racial justice for Black/African American and Indigenous American people in commercial tobacco product regulation.

Although overall health in the United States (US) has improved dramatically during the past century, long-standing health inequities, particularly the unequal and unjust burden of tobacco-related disease and death among racialized populations, persist. A considerable gap exists in our understanding of how commercial tobacco product regulations and policies cause and/or exacerbate race-based health inequities among Black/African American (B/AA) and Indigenous American people. The purpose of this paper is to 1) describe how existing US commercial tobacco regulatory policies may contribute to structural racism and undermine the full benefits of tobacco prevention and control efforts among B/AA and Indigenous American groups; and 2) initiate a call to action for researchers and regulators of tobacco products to examine policies using an equity lens. These actions are imperative if empirically-informed regulation of commercial tobacco products is to address health equity.

Factors associated with smokefree rules in the homes of Black/African American women smokers residing in low-resource rural communities.

Little is known about the implementation of voluntary policies in the homes of Black/African American women smokers who live in rural areas where health care access is limited. This paper examines 1) the sample's prevalence of comprehensive smoke-free rules; 2) sociodemographic, social, and smoking characteristics of women by home rule type; and 3) the association of social indicators with the outcome complete ban on smoked tobacco use in the home (n = 191). Families Rising to Enforce Smokefree Homes collected baseline data from 2019 to 2021 prior to randomization to an intervention that aimed to increase comprehensive smokefree policies in the homes African American women living in the rural Delta region of Arkansas. The primary outcome was implementation of a complete ban on all smoked tobacco products anywhere inside the home. Results showed that 26% of women had a rule that completely banned all smoked tobacco products in the home. Women who reported having no ban were more likely to be employed part-time (50.0%), while women with a partial (66.9%) or complete ban (60.0%) were more likely to not currently work for pay. Women who indicated that they just meet basic expenses and meet needs with little left had significantly lower odds of having a complete ban on smoked tobacco in the home than women who indicated that they live comfortably. Perceived financial security may be a motivating factor that helps women keep their homes free from all smoked tobacco products (# NCT03476837).

Electronic cigarette users' reactions and responses to a hypothetical ban of flavoured electronic cigarette liquids.

BackgroundRegulations have been proposed to limit e-cigarette flavours, but limited research has examined potential impacts of such policies. This study examined adult e-cigarette users' reactions to a hypothetical e-cigarette flavour ban. METHODS: In 2019, a convenience sample of current e-cigarette users in the USA (n=81, 53.1% women, mean age=37.6, 59.3% dual users of cigarettes) completed an online concept mapping study. Participants provided statements describing anticipated reactions to a hypothetical policy in which only tobacco, menthol or unflavoured e-cigarettes were available for purchase. Seventy-one unique statements were generated. Participants sorted statements into thematic groups and rated statements on how likely they would be to have each reaction. Multidimensional scaling was used to identify thematic clusters of statements. RESULTS: Twelve clusters were identified: negative reaction, take action against flavour limitation, youth prevention effectiveness perception, tolerance, acceptance, willingness to try new flavours, maintain vaping, reduce vaping, new flavours as vaping cessation transition, alternative sources for banned flavours, do-it-yourself mixing behaviours and alternative tobacco products. The highest rated cluster (negative reaction) described being angry or upset that flavours were banned, while the lowest rated clusters related to quitting/reducing e-cigarette use or switching to other tobacco products. Non-tobacco or non-menthol/mint flavoured e-cigarette users had higher ratings for clusters describing negative sentiment for the hypothetical policy. CONCLUSIONS: Some e-cigarette users may dislike an e-cigarette flavour ban; however, some e-cigarette users would likely be willing to use tobacco, menthol or unflavoured e-cigarette liquids with lower likelihood of quitting vaping or switching to other tobacco products.

Racial Discrimination and Alcohol Problems: Examining Interactions with Genetic Risk and Impulsivity among African American Young Adults.

Experiences of racial discrimination have been shown to increase risk for alcohol problems. Some individuals may be particularly vulnerable to the negative effects of racial discrimination. However, little research has examined interaction effects between racial discrimination and individual characteristics, such as genetic predispositions and personality, in relation to alcohol outcomes. This study examined whether genetic risk and dimensions of impulsivity moderate the association between racial discrimination and alcohol problems among African American young adults (n = 383, Mage = 20.65, SD = 2.28; 81% female). Participants completed online surveys and provided a saliva sample for genotyping. Results from multiple regression analyses indicated that both blatant and subtle forms of racial discrimination (i.e., experience of racist events and racial microaggressions) were associated with more alcohol problems. Racial microaggressions interacted with dimensions of impulsivity in relation to alcohol problems, such that racial microaggressions were associated with more alcohol problems when negative urgency was high or when sensation seeking was low. There was no significant interaction between alcohol use disorder genome-wide polygenic score and experience of racist events or racial microaggression in relation to alcohol problems, which may partly reflect low power due in part to limited representation of African-Americans in genetic research. The findings highlight the need to increase the representation of African Americans in genetically-informed research in order to better characterize genetic risk and understand gene-environment interaction in this understudied population, as well as the importance of examining impulsivity as a multidimensional construct that interacts with racial discrimination in relation to alcohol outcomes.

Characterization of Electronic Cigarette Warning Statements Portrayed in YouTube Videos.

INTRODUCTION: In 2018, the United States Food and Drug Administration (FDA) required that electronic cigarette (e-cigarette) manufacturers, packagers, importers, distributors, and retailers display an addictive or alternate warning statement on e-cigarette visual advertisements. Few studies have investigated the FDA-mandated and other warnings on social media. This study examined the prevalence and content of warning statements in e-cigarette-related YouTube videos. METHODS: In 2019, The Virginia Commonwealth University Center for the Study of Tobacco Products conducted bi-monthly (February-June) YouTube searches by relevance and view count to identify e-cigarette-related videos. Overall, 178 videos met the inclusion criteria. Staff coded each video for the presence of a visual/verbal warning statement, warning statement type (eg, FDA-mandated, addiction/tobacco, safety/toxic exposure, health effects), sponsorship, and tobacco product characteristics. A data extraction tool collected the video URL, title, upload date, and number of views, likes/dislikes, and comments. RESULTS: Only 5.1% of videos contained FDA-mandated and 21.9% contained non-mandated warnings. All videos with FDA-mandated and 46.2% of non-mandated warnings were represented visually. Only 13.1% of industry-sponsored videos uploaded after the mandate effective date had an FDA-mandated warning statement and videos with FDA-mandated and non-mandated (v. no) warnings had significantly fewer views, likes, dislikes, and comments. Among all non-mandated warnings, 31.3% featured an addiction/tobacco, 18.8% a safety/toxic exposure, and 37.5% a health effects warning. CONCLUSIONS: The prevalence of FDA-mandated warning statements in e-cigarette related YouTube videos was low. FDA enforcement of the warning statement mandate on YouTube could increase the public's understanding of the addictive nature of nicotine in e-cigarettes. IMPLICATIONS: The FDA has the authority to regulate the advertisement and promotion of e-cigarettes on the Internet. These data can inform future FDA requirements related to the language content and visual representation of addiction/tobacco, safety/exposure, and health effects warning statements that appear in YouTube videos and other visual social media popular among young people. Such data would help consumers make informed decisions about purchasing e-cigarette products, using e-cigarettes, and avoiding unintentional harm related to e-cigarettes. In addition, these data may help social media platforms make decisions on whether they will prohibit advertisements that promote or facilitate the sale of tobacco products.

User-Perceived Negative Respiratory Symptoms Associated with Electronic Cigarette Use.

INTRODUCTION: Electronic cigarettes (ECIGs) expose users to an aerosol containing chemicals, which could affect the respiratory system negatively. This study examined negative respiratory symptoms associated with ECIG use. METHODS: In 2019, adult current ECIG users from 24 US states who reported experiencing negative respiratory symptoms from ECIG use (n = 49; 44.9% women; mean age = 35.2, SD = 11.5) completed an online survey and brainstormed statements that completed the prompt: "A specific negative effect or symptom related to my breathing, nose, mouth, throat, or lungs that I have experienced from vaping/using my e-cigarette is..." Participants sorted the final list of 56 statements into groups of similar content and rated statements on how true they were for them. Multidimensional scaling analysis identified thematic clusters. RESULTS: Eight ECIG use respiratory symptom clusters identified in analysis included Mucus and Congestion, Fatigue, Throat Symptoms, Breathing Problems, Mouth Symptoms, Chest Symptoms, Illness Symptoms, and Nose and Sinus Symptoms. Highly rated (ie, most common) symptoms included dry throat or mouth, fatigue during physical activity, coughing, shortness of breath, excessive phlegm, and bad taste in mouth. Mean cluster ratings did not differ based on lifetime cigarette smoking status (100 lifetime cigarettes smoked), but current cigarette smokers (ie, dual users) rated the Fatigue, Breathing Problems, Mucus and Congestion, and Nose and Sinus Symptoms clusters higher than noncurrent cigarette smokers. CONCLUSIONS: Participant-identified respiratory symptoms perceived to be ECIG related, many similar to cigarette smoking symptoms. Future research should assess if these symptoms are associated with other negative health outcomes. IMPLICATIONS: ECIG use exposes users to chemicals that may have negative health impacts on the respiratory system. Limited research has examined the broad range of negative respiratory symptoms associated with e-cigarette use. This study identified that ECIG-cigarette users perceive their ECIG use to be associated with negative respiratory symptoms. Many e-cigarette user-reported negative respiratory symptoms are similar to those associated with cigarette smoking, though some appear unique to e-cigarette use. Future research should continue to monitor respiratory symptoms reported by ECIG users and whether these are associated with health outcomes over time.

Racial discrimination and alcohol problems among African American young adults: Examining the moderating effects of racial socialization by parents and friends.

OBJECTIVE: Racial discrimination is a stressor that may put African Americans at risk for alcohol use and related problems. We examined whether experiences of blatant (racist events) and subtle (racial microaggressions) forms of racial discrimination were associated with alcohol consumption and alcohol problems among African American young adults, and whether childhood/adolescence racial socialization by parents and friends moderated these associations. METHOD: The sample included 383 African American young adults (Mage = 20.65, SD = 2.28; 81% female) who completed an electronic survey in Fall, 2017. Hierarchical linear regression analyses were conducted in Mplus. RESULTS: Experiences of racist events and racial microaggressions were associated with higher levels of alcohol consumption and more alcohol problems. Racial socialization by friends, but not parents, moderated these associations. Specifically, cultural socialization by friends buffered the effect of racist events on alcohol consumption and alcohol problems, whereas promotion of mistrust by friends exacerbated the effect of racial microaggressions on alcohol problems. CONCLUSIONS: Both blatant and subtle forms of racial discrimination were associated with higher risk for alcohol use or problems among African American young adults. Racial socialization by friends while growing up may play an important role in alcohol use outcomes during young adulthood. Findings highlight the importance of considering different forms of racial discrimination and emphasize the unique roles of racial socialization across different social contexts (i.e., parent and peers or friends) in relation to psychosocial outcomes among African American individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Orthodox and Unorthodox Uses of Electronic Cigarettes: A Surveillance of YouTube Video Content.

INTRODUCTION: Open electronic cigarette (e-cigarette) systems are customizable by consumers and often allow for potential "unorthodox" use of the product; that is, use not as intended by the manufacturer. Little is known about the types and prevalence of unorthodox uses and how these practices are transmitted via popular social media. METHODS: Monthly searches of YouTube were conducted from June through November 2016 using the following search terms: "e-cigarettes," "vaping," and "e-juice." After collecting static and dynamic data on the 150 videos identified, two coders independently coded videos for general information, unorthodox use behaviors, health claims, and production quality and characteristics for orthodox and unorthodox use. Intercoder reliability was high (Cohen's κ 0.81, p < .001). RESULTS: One hundred fifty videos were included in the study with a total of 115 551 563 views. We identified nine categories of unorthodox uses of e-cigarettes. Unorthodox use was three times as prevalent as orthodox use. Seventy-seven percent of the unorthodox use videos included recreational e-cigarette use, 57% included modification of mechanical parts and components, and 44.6% included unorthodox substance application (dripping). There were more than twice as many social media links in videos depicting unorthodox compared to orthodox use, but the level of engagement was lower for unorthodox use. CONCLUSIONS: E-cigarette unorthodox use on YouTube is more prevalent than orthodox use, suggesting the need to further investigate the prevalence of unorthodox use among e-cigarette users and the influence of social media on consumer uptake of unorthodox and orthodox uses of e-cigarettes. IMPLICATIONS: The US Food and Drug Administration has regulatory authority over e-cigarettes, parts and components. Many e-cigarettes currently marketed are open systems. Closed systems may allow less manipulation and may influence the safety of these products. This study provides valuable information on ways that open system e-cigarettes are used and it can inform safety tests that can be conducted by the US Food and Drug Administration to determine whether or not these products should remain on the market. In addition, our definitions of unorthodox use can be incorporated into the Population Assessment of Tobacco on Health Study to better understand the prevalence of these behaviors.

Hookah Use Among US Youth: A Systematic Review of the Literature From 2009 to 2017.

INTRODUCTION: Given the US Food and Drug Administration (FDA)'s authority to regulate hookah, more research is needed to inform regulations intended to prevent youth from using hookah. This systematic review summarizes and assesses the literature related to hookah use among adolescents (11 to ≤18 years of age) in the United States from 2009 to 2017. METHODS: Database searches yielded 867 peer-reviewed articles. After duplicates were removed, authors reviewed 461 articles for inclusion. Included articles (n = 55) were coded for study themes, study quality, and their relevance to FDA's research priorities. A qualitative synthesis is presented. RESULTS: The following themes were identified: (1) prevalence of hookah use (n = 42), (2) tobacco use transitions (n = 7), (3) sociodemographic correlates (n = 35), (4) psychosocial risk factors (n = 21), (5) concurrent use of other tobacco products (n = 31), (6) concurrent use of other substances (n = 9), and (7) other (n = 15)-which includes low prevalence themes. The qualitative synthesis showed increasing rates of hookah use. Older age, male gender, positive social normative beliefs, higher peer use, as well as lower perceived risk were associated with hookah use. Longitudinal studies of youth hookah use showed bidirectional relationships between use of hookah and other tobacco products. All articles fell within FDA's research priority related to "behavior," and three priorities ("impact analysis," "health effects," and "toxicity") have not been explored for hookah use among US youth since 2009. CONCLUSIONS: The prevalence of hookah use among youth in the United States is increasing, thus more research is needed to inform policies targeted to protect this vulnerable population. IMPLICATIONS: This study represents a novel contribution to our understanding of hookah use among youth in the United States from 2009-the year that the Family Smoking Prevention and Tobacco Control Act was passed-to 2017. In recent years, hookah has become a more popular tobacco product among US youth; however, to date, no systematic reviews of hookah use among this population exist. Results highlight implications for future US FDA regulatory policy and identify gaps in research to be addressed in future studies.

Influence of Parental Alcohol Dependence Symptoms and Parenting on Adolescent Risky Drinking and Conduct Problems: A Family Systems Perspective.

BACKGROUND: Parental alcohol problems are associated with adverse adolescent outcomes such as risky drinking and conduct problems. Important questions remain about the unique roles of fathers' and mothers' alcohol problems and differences and/or similarities in pathways of risk across ethnicity and gender. In this study, we used a family systems approach to consider spillover and crossover effects of fathers' and mothers' alcohol problems (number of alcohol dependence symptoms [ADS]) and parenting behaviors in relation to adolescents' risky drinking and conduct problems. METHODS: The sample included 1,282 adolescents (aged 12 to 17) and their parents from the Collaborative Study on the Genetics of Alcoholism. Parents completed the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA), and adolescents completed an adolescent version of SSAGA. Data were analyzed using multivariate structural equation modeling. RESULTS: Fathers' ADS count was associated with higher adolescent risky drinking and conduct problems indirectly via disruption to fathers' and mothers' positive parenting behaviors, whereas mothers' ADS count was not associated with adolescents' risky drinking and conduct problems directly or indirectly via positive parenting behaviors. No differences in these associations were found across ethnic background and offspring gender. CONCLUSIONS: Findings highlight the importance of considering the unique roles of fathers' and mothers' ADS in influencing family processes and adolescent outcomes.

Sugar and Aldehyde Content in Flavored Electronic Cigarette Liquids.

Introduction: Sugars are major constituents and additives in traditional tobacco products, but little is known about their content or related toxins (formaldehyde, acetaldehyde, and acrolein) in electronic cigarette (e-cigarette) liquids. This study quantified levels of sugars and aldehydes in e-cigarette liquids across brands, flavors, and nicotine concentrations (n = 66). Methods: Unheated e-cigarette liquids were analyzed using liquid chromatography mass spectrometry and enzymatic test kits. Generalized linear models, Fisher's exact test, and Pearson's correlation coefficient assessed sugar, aldehyde, and nicotine concentration associations. Results: Glucose, fructose and sucrose levels exceeded the limits of quantification in 22%, 53% and 53% of the samples. Sucrose levels were significantly higher than glucose [χ2(1) = 85.9, p < .0001] and fructose [χ2(1) = 10.6, p = .001] levels. Formaldehyde, acetaldehyde, and acrolein levels exceeded the limits of quantification in 72%, 84%, and 75% of the samples. Acetaldehyde levels were significantly higher than formaldehyde [χ2(1) = 11.7, p = .0006] and acrolein [χ2(1) = 119.5, p < .0001] levels. Differences between nicotine-based and zero-nicotine labeled e-cigarette liquids were not statistically significant for sugars or aldehydes. We found significant correlations between formaldehyde and fructose (-0.22, p = .004) and sucrose (-0.25, p = .002) and acrolein and fructose (-0.26, p = .0006) and sucrose (-0.21, p = .0006). There were no significant correlations between acetaldehyde and any of the sugars or any of the aldehydes and glucose. Conclusions: Sugars and related aldehydes were identified in unheated e-cigarette liquids and their composition may influence experimentation in naïve users and their potential toxicity. Implications: The data can inform the regulation of specific flavor constituents in tobacco products as a strategy to protect young people from using e-cigarettes, while balancing FDA's interest in how these emerging products could potentially benefit adult smokers who are seeking to safely quit cigarette smoking. The data can also be used to educate consumers about ingredients in products that may contain nicotine and inform future FDA regulatory policies related to product standards and accurate and comprehensible labeling of e-cigarette liquids.

Warning Statements and Safety Practices Among Manufacturers and Distributors of Electronic Cigarette Liquids in the United States.

Introduction: Prior to the US Food and Drug Administration's (FDA) regulation of electronic cigarettes and warning statements related to nicotine addiction, there was no critical examination of manufacturer/distributor voluntary practices that could potentially inform FDA actions aimed to protect consumers. This study examined the content of warning statements and safety characteristics of electronic cigarette liquid bottles using a national sample. Methods: Research staff randomly selected four electronic cigarette liquid manufacturers/distributors from four US geographic regions. Staff documented the characteristics of product packaging and content of warning statements on 147 electronic cigarette liquids (0-30 mg/ml of nicotine) purchased online from 16 manufacturers/distributors in April of 2016. Results: Data showed that 97.9% of the electronic cigarette liquid bottles included a warning statement, most of which focused on nicotine exposure rather than health. Only 22.4% of bottles used a warning statement that indicated the product "contained nicotine." Of bottles that advertised a nicotine-based concentration of 12 mg/ml, 26% had a warning statements stated that the product "contains nicotine." None of the statements that indicated that the product "contained nicotine" stated that nicotine was "addictive." All bottles had a safety cap and 12% were in plastic shrink-wrap. Fifty-six percent of the websites had a minimum age requirement barrier that prevented under-aged persons from entering. Conclusions: Most manufacturers/distributors printed a warning statement on electronic cigarette liquid bottles, but avoided warning consumers about the presence and the addictiveness of nicotine. Studies are needed to examine manufacturer/distributor modifications to product packaging and how packaging affects consumer behaviors. Implications: These data can inform future FDA requirements related to the packaging and advertising of e-cigarette liquids; regulation related to the content of warning statements, including exposure warning statements, which are not currently mandated; and requirements on websites or language on packaging to help manufacturers adhere to the minimum age of purchase regulation. The data can also be used to help FDA develop additional guidance on the framing of statements on packaging that helps consumers make informed decisions about purchasing the product or protecting young people from use or unintentional exposure to the product.

Examining interactions between genetic risk for alcohol problems, peer deviance, and interpersonal traumatic events on trajectories of alcohol use disorder symptoms among African American college students.

Numerous studies have demonstrated that genetic and environmental factors interact to influence alcohol problems. Yet prior research has primarily focused on samples of European descent and little is known about gene-environment interactions in relation to alcohol problems in non-European populations. In this study, we examined whether and how genetic risk for alcohol problems and peer deviance and interpersonal traumatic events independently and interactively influence trajectories of alcohol use disorder symptoms in a sample of African American students across the college years (N = 1,119; Mage = 18.44 years). Data were drawn from the Spit for Science study where participants completed multiple online surveys throughout college and provided a saliva sample for genotyping. Multilevel growth curve analyses indicated that alcohol dependence genome-wide polygenic risk scores did not predict trajectory of alcohol use disorder symptoms, while family history of alcohol problems was associated with alcohol use disorder symptoms at the start of college but not with the rate of change in symptoms over time. Peer deviance and interpersonal traumatic events were associated with more alcohol use disorder symptoms across college years. Neither alcohol dependence genome-wide polygenic risk scores nor family history of alcohol problems moderated the effects of these environmental risk factors on alcohol use disorder symptoms. Our findings indicated that peer deviance and experience of interpersonal traumatic events are salient risk factors that elevate risk for alcohol problems among African American college students. Family history of alcohol problems could be a useful indicator of genetic risk for alcohol problems. Gene identification efforts with much larger samples of African descent are needed to better characterize genetic risk for alcohol use disorders, in order to better understand gene-environment interaction processes in this understudied population.

Review: Genetic research on alcohol use outcomes in African American populations: A review of the literature, associated challenges, and implications.

BACKGROUND AND OBJECTIVES: There have been remarkable advances in understanding genetic influences on complex traits; however, individuals of African descent have been underrepresented in genetic research. METHODS: We review the limitations of existing genetic research on alcohol phenotypes in African Americans (AA) including both twin and gene identification studies, possible reasons for underrepresentation of AAs in genetic research, the implications of the lack of racially diverse samples, and special considerations regarding conducting genetic research in AA populations. RESULTS: There is a marked absence of large-scale AA twin studies so little is known about the genetic epidemiology of alcohol use and problems among AAs. Individuals of African descent have also been underrepresented in gene identification efforts; however, there have been recent efforts to enhance representation. It remains unknown the extent to which genetic variants associated with alcohol use outcomes in individuals of European and African descent will be shared. Efforts to increase representation must be accompanied by careful attention to the ethical, legal, and social implications of genetic research. This is particularly true for AAs due to the history of abuse by the biomedical community and the persistent racial discrimination targeting this population. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Lack of representation in genetic studies limits our understanding of the etiological factors that contribute to substance use and psychiatric outcomes in populations of African descent and has the potential to further perpetuate health disparities. Involving individuals of diverse ancestry in discussions about genetic research will be critical to ensure that all populations benefit equally from genetic advances. (Am J Addict 2017;26:486-493).