Variances in Smoking Expectancies Predict Moment-to-Moment Smoking Behaviors in Everyday Life.

BACKGROUND: Many policy decisions about tobacco control are predicated on rational choice models, which posit (1) that smokers are aware of the risks of cigarettes and (2) that perceived risks have a consistent influence on continued smoking behavior. However, research shows that beliefs about smoking may be vulnerable to changes in internal and external contexts. METHODS: Using ecological momentary assessment, we tested this by measuring how smokers' (N = 52) beliefs about smoking varied over time. Four times per day over 1 week, participants responded to measures of smoking intentions, risk perceptions, mood and social outcome expectancies, and internal and external contextual factors. RESULTS: We analyzed this data using multilevel modeling, finding that both smoking intentions, risk perceptions, and expectancies differed between participants as well as between moments. CONCLUSION: Risk perceptions and mood expectancies were a significant predictor of intentions to smoke in the next 30 min, illustrating the importance of these beliefs in decisional processes. This study was preregistered at the Open Science Foundation: https://osf.io/wmv3s/?view_only=71ad66d3ce3845fcb3bf2b9860d820c9 . Our analytic plan was not preregistered.

Marijuana and E-cigarette Initiation Among Adolescents: A Survival Analysis.

PURPOSE: Prior literature suggests marijuana and e-cigarette initiation among adolescents is surpassing combustible cigarette uptake. Marijuana and nicotine co-use is also a concern as these products grow in popularity. Initiation trajectories for marijuana and e-cigarette products are not well understood, let alone how the use of one product may impact initiation susceptibility for the other. METHODS: We used national longitudinal data from the Population Assessment of Tobacco and Health study from 2013 to 2018. Eighth graders in Wave 1 made up the analytic sample (N = 2,270). We employed discrete time survival analyses to determine the likelihood of initiating marijuana and e-cigarettes between Waves 2 and 5. We used survival analyses to estimate the relationships between prior cigarette and marijuana use and subsequent e-cigarette initiation, as well as prior cigarette and e-cigarette use and subsequent marijuana initiation. RESULTS: Previous marijuana initiation was associated with later e-cigarette initiation (odds ratio = 6.88, 95% confidence interval [4.89, 9.67]). Previous e-cigarette initiation was associated with later marijuana initiation (odds ratio = 9.28, 95% confidence interval [6.86, 12.56]). By wave 5, adolescents were more than 42% likely to initiate marijuana and e-cigarettes. DISCUSSION: Susceptibility to marijuana and e-cigarette products starts as early as eighth grade and increases over time. The use of one product is significantly related to later initiation for the other. Rather than addressing marijuana and nicotine as separate concerns, interventions may benefit by recognizing the closely related nature of these products.

Will tobacco price increases lead more people who smoke to vape? The results from a discrete choice experiment amongst U.S. adults.

OBJECTIVE: To understand the extent to which people who smoke, people who vape and nonsmokers would switch between smoking cigarettes and vaping in response to policies (price increases, restrictions on nicotine, places, and information on addictiveness and/or health risks) aimed at decreasing tobacco use by people who smoke and vaping by nonsmokers. DESIGN: A total of 525 adults aged 18 to 88 years completed a discrete choice survey of 16 choices between two smoking/vaping alternatives. Analysis was conducted using conditional logistic regression for the entire sample and stratified by nonsmokers, people who smoke, and people who vape. RESULTS: The results suggest that most people who vape also smoke. Nonsmokers were more favorable to vaping and were concerned about long-term health risks and cost associated with vaping. Marginal analysis suggests that price increases will have only modest success in moving people who smoke to start vaping or encouraging people who vape to vape rather than use cigarettes. Nonsmokers are not very sensitive to price changes but are sensitive to information about health impacts. CONCLUSIONS: Findings indicate that increasing the price of cigarettes would lead to a limited increase in the probability of people who smoke switch to vaping. The study advances our understanding of the views of current nonsmokers toward cigarettes and vaping, suggesting that price increases and increased knowledge of addiction would likely deter nonsmokers from vaping. Changing the amount of nicotine associated with smoking would increase the probability of vaping slightly and have little impact on nonsmokers or vaping preferences, but the most significant change would come from increasing the perceptions of the risk of smoking.

Perceptions of COVID-related risks among people who smoke: A mediation model.

The COVID-19 pandemic provides both reasons to quit smoking as well as stress that may promote increased cigarette consumption. Perceptions of COVID-19 risk related to smoking may motivate cessation among smokers. At the same time, other evidence shows that affective perceptions (i.e., worry) could lead to increased smoking as a coping mechanism. Using a sample drawn from a rural region of California (N = 295), we examined the relationship between perceptions about health risks for smokers during the pandemic and both reported increases in smoking frequency and intentions to quit smoking. We also examined whether worry about health risks mediated these relationships. High perceived risk was associated both with reported increases in smoking frequency as well as greater intentions to quit smoking. Worry partially mediated both these relationships, with worry accounting for 29.11% of the variance in the relationship between high risk perceptions and increased smoking as well as 20.17% of the relationship between risk perceptions and intentions to quit smoking. These findings suggest that while smokers' awareness about their increased risk of COVID-19 can motivate intent to quit smoking in the future, smokers may require greater support to act on these intentions.

Peer victimization and relationships to approach and avoidance coping to health and health behaviors.

Peer victimization during high school is a common experience associated with engagement in risky health behaviors and elevated depressive symptoms. Mechanisms linking peer victimization to health outcomes remain inadequately understood. In the current study, latent class analysis was used to identify latent subclasses of college students who display similar patterns of responses to frequent peer victimization experiences during high school. We also examined moderating and mediating effects of coping (approach/avoidance) on relationships between victimization class and health outcomes (i.e., binge drinking, current smoking, depressive symptoms). College students completed questionnaire measures of peer victimization, approach and avoidance coping, binge drinking, smoking, and depressive symptoms. Four distinct patterns of peer victimization were identified among college students (Low, High, Moderate, and Social/Verbal). Moderation models revealed significant interactions of moderate victimization x approach coping on depressive symptoms and high victimization x avoidance coping on binge drinking. Mediation models revealed a significant indirect effect of avoidance coping on depressive symptoms for those in the high victimization class. Findings provide a greater understanding of the complex patterns of peer victimization. Coping efforts among varying peer victimization classes had different relationships with health outcomes during the college years. Interventions aimed at reducing health-risk and depressive symptoms among college student might benefit from increased attention to high school victimization experiences and current coping processes.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1946468 .

Public support for policies to regulate flavoured tobacco and e-cigarette products in rural California.

INTRODUCTION: Flavoured tobacco control policy exemptions and electronic cigarette products may contribute to increased youth access and tobacco use disparities. METHODS: We assessed public support among California Central Valley residents for four policies to regulate flavoured tobacco products and e-cigarettes. The probability-based, multimode survey was conducted with English-speaking and Spanish-speaking registered voters (n=845) across 11 counties between 13 and 18 August 2020. Weighted logistic regression analyses measured odds of policy support, adjusting for predictor variables (attitudes and beliefs) and covariates. RESULTS: The weighted sample was 50% female and predominantly Latino (30%) or non-Hispanic white (46%); 26% had a high school education or less, and 22% an annual household income

An observational study of the extent of naloxone furnishing in California Central Valley community pharmacies.

BACKGROUND: California has sought to expand medication access and improve public health by authorizing pharmacists in California to prescribe certain medications since 2014. Medications with pharmacist-initiated prescribing, or furnishing, include naloxone, hormonal contraception, postexposure prophylaxis/preexposure prophylaxis, and nicotine replacement therapy. In light of the United States' opioid epidemic, naloxone, an opioid antagonist, this study considered furnishing rates in urban areas of California. Research from 2020 found 42.5% of pharmacies furnished naloxone. However, there has been limited study of furnishing outside of urban areas. OBJECTIVE: This study assessed pharmacist furnishing rates of naloxone in California's Central Valley and identified barriers and facilitators to implementation. METHODS: From April to May 2022, the researchers first conducted a cross-sectional, observational study of community and mail-order pharmacies in California's largely rural Central Valley, then collected interview data from a subset of pharmacists in stores that indicated they furnished naloxone. RESULTS: Forty-three percent of Central Valley pharmacies reported that they furnished naloxone. Interview respondents reported that barriers to furnishing included time restrictions, cost to patients, stigma, and language barriers. CONCLUSIONS: Furnishing rates in the Central Valley were slightly higher (43.4%) than those reported in previous research focusing on urban areas of California (42.5%). Identified barriers to furnishing were consistent with those identified in previous research. These findings suggest that further policy interventions may be needed to reduce out-of-pocket costs, establish stronger pharmacist-provider relationships, and provide education combatting stigma against opioid users to increase naloxone furnishing.

Why do smokers use e-cigarettes? A study on reasons among dual users.

Objective: There is minimal research that has measured motivations behind e-cigarette use and the relationship to cigarette and e-cigarette use. The aim of this study was to (1) examine extent to which motivations to use e-cigarettes varies among dual users and (2) examine whether e-cigarette motivations are related to e-cigarette and cigarette consumption among dual users. Methods: Adults residing in California were recruited through social media (n = 1762, 68.9 % males, 62.9 % White) to complete an online survey. Participants self-identified as using combustible cigarettes and e-cigarettes (dual users) and reported their motivations for using an e-cigarette device, nicotine consumption, and nicotine dependence with both combustible cigarettes and e-cigarettes. Results: A greater proportion of people reported using e-cigarettes for enjoyment purposes than other motivations (34.2 %). Motivations to use e-cigarettes to quit were positively related to monthly cigarette consumption (IRR = 1.17, 95 % CI [1.08, 1.26]). Motivations to use e-cigarettes to quit smoking were also related to smoking the first cigarette within 30 min (IRR = 1.46, 95 % CI [1.05, 2.02]) and first e-cigarette within 30 min (b = 0.28, 95 % CI [0.19, 0.37]). Conclusions: Compared to those who use e-cigarettes for enjoyment, smokers who are motivated to use e-cigarettes for cessation purposes are more likely to have greater nicotine dependence, cigarette consumption, and e-cigarette consumption. Future research needs to acknowledge that not all e-cigarette users are the same; motivations and use differ and are related to both consumption and dependence.

Worry as a mechanism of the relationship between perceived new knowledge and discouragement to smoke elicited from graphic cigarette warnings.

Evidence supports the use of graphic warnings to educate the public about the health harms of smoking and suggests warnings eliciting negative emotional responses may be more effective. This study aimed to replicate a preliminary theory-based model whereby perceived new knowledge promotes discouragement from smoking through its impact on worry about smoking with a different sample and using a new set of cigarette graphic warnings. We explored if the pattern extended to encouragement to use e-cigarettes, and if age and user group moderated the indirect effects of these models. Exclusive smokers, dual/e-cigarette users and nonusers (N = 412) evaluated graphic cigarette warnings on perceived new knowledge and worry about health harms of smoking, discouragement to smoke, and encouragement to use e-cigarettes. Perceived new knowledge was both directly and indirectly associated with discouragement to smoke through worry about health harms of smoking, and did not vary as a function of age or user group. In contrast, perceived new knowledge was not directly or indirectly associated with encouragement to use e-cigarettes, and this pattern largely did not vary as a function of age or user group. Graphic cigarette warnings that enhance knowledge may discourage smoking both directly and indirectly through worry elicited by them, and may have less impact on encouraging e-cigarette use. These findings replicate prior work and generalize to different user groups and new warnings planned for implementation in the U.S.

How Socioeconomic Status and Acculturation Relate to Dietary Behaviors Within Latino Populations.

PURPOSE: Despite having lower socioeconomic status, Latinos in the US experience fewer adverse health outcomes than non-Latinos. However, they are disproportionately affected by diet-related diseases. Among other racial/ethnic groups, high acculturation and low socioeconomic status are associated with worse dietary intake, yet, few studies have investigated these relationships among Latinos. DESIGN: 2013-2014 NHANES analyzed to examine pathways through which acculturation, income, nativity, and food security are associated with dietary behaviors. SETTING: U.S. population-based survey. SAMPLE: Survey respondents >18 years old and identified as Latino/Hispanic (N = 1197; 53.88% female; Mage = 44.61). MEASURES: Primary language spoken (acculturation), total household income (income), place of birth (nativity), Food security, and the Flexible Consumer Behavior Survey (dietary behavior). ANALYSIS: Univariate and multivariate regressions in STATA. Covariates include length of time in the US, ethnicity/Hispanic origin (i.e., "Mexican American" or "Other Hispanic"), and gender. RESULTS: Nativity (ß = -1.16; SE = .19; P < .001) and income (ß = .39; SE = .07; P < .001) were significant predictors of dietary behavior. Foreign-born Latinos and those with lower income consumed significantly lower numbers of fast-food or pizza. Food security was not a significant predictor of dietary behavior (ß = .16; SE = .1; P > .05). CONCLUSIONS: Results suggest that income is not a protective factor against unhealthy dietary behavior and a renewed importance of nativity as a predictor of health behavior among Latinos.

Challenging Assumptions About Race/Ethnicity, Socioeconomic Status, and Cigarette Smoking Among Adolescents.

BACKGROUND: Previous research indicates that differences in cigarette smoking exist among those of different race/ethnicity and varying levels of socioeconomic status. However, most research has examined the influence of these factors separately on cigarette smoking despite their observed covariation. To examine the interaction of race/ethnicity and socioeconomic status on adolescent tobacco use and behaviors, this study tests whether or not the social gradient holds for smoking patterns and perceptions of smoking among African American, American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents. METHODS: Using data from the 2018 National Survey on Drug Use and Health, the sample included African American/Black (Black), American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents (N = 12,474), ages 12-17 years old. Measures included race/ethnicity, annual household income, age, gender, cigarette smoking, perceptions of peer use, parental attitudes, and health risks of smoking; logistic regression analyses were conducted. RESULTS: Findings indicated significant interactions between high income and Black and Hispanic race/ethnicity for having ever smoked a cigarette indicating a difference in comparison to high-income White adolescents (p's < 0.05). We also found that the interaction between high income and AIAN race/ethnicity for disapproval of peers smoking was significant compared to White adolescents at the same income levels (p < 0.05). No differences were found for smoking health risk perceptions. CONCLUSIONS: The relationship between race/ethnicity, income, and smoking may be more complex than previously thought with these results having important preventative implications for identification of adolescents who may be most at risk for tobacco use.

County-Level Recreational Marijuana Policies and Local Policy Changes in Colorado and Washington State (2012-2019).

Policy Points In 2012, Colorado and Washington were the first states to legalize recreational marijuana through voter-initiated ballots. In these states, counties could restrict or ban local marijuana facilities through a variety of regulatory methods such as ordinances and zoning. County-level recreational marijuana policies in Washington and Colorado vary substantially, with 69.2% of Washington counties and 23.4% of Colorado counties allowing all types of recreational marijuana facilities as of April 1, 2019. After Colorado and Washington legalized recreational marijuana, many counties modified their marijuana policies over time, with shifts in county policy often preceded by advocacy and information-seeking activities. CONTEXT: In 2012, Colorado and Washington were the first states to legalize recreational marijuana. Both allowed local governments to further regulate the availability of marijuana facilities in their jurisdictions. As early adopters, these states are important quasi-natural experiments to examine local marijuana policy and policy change processes, including key stakeholders and arguments. METHODS: We conducted a policy scan of county-level recreational marijuana ordinances and regulations in Colorado and Washington. Data collected included policy documents from counties in both states and newspaper articles. We used a mixed-methods approach to describe the types of county-level recreational marijuana policies enacted by April 1, 2019; identify key policy stakeholders involved in local policy debates; and explore arguments used in support or opposition of county policies. We also selected four counties that represent three county policy environments (all marijuana facility types allowed, some marijuana facility types allowed, all marijuana facility types prohibited) and described the policy changes within these counties since recreational marijuana was legalized. FINDINGS: By April 1, 2019, Colorado counties were less likely than Washington counties to allow marijuana facilities-48.4% of Colorado counties prohibited recreational marijuana facilities in their jurisdiction compared to 23.1% of Washington counties. Since state legalization, several counties in both states have made substantial marijuana facility policy modifications, often preceded by information-seeking activities. Primary stakeholders involved in policy debates included elected officials, law enforcement, individual growers/farmers, marijuana business license applicants, parents, and residents. Proponents referenced local economic gain, reduced crime, and potential health benefits of marijuana as arguments in favor of permitting local facilities, whereas opponents pointed to economic loss, negative health and public health issues, public safety concerns, and existing federal law. Both sides referenced local public opinion data to support their position. CONCLUSIONS: By early 2019, a patchwork of local marijuana policies was in place in Colorado and Washington. We identify key areas of policy and public health research needed to inform future local marijuana policy decisions, including the impact of legalization on public health outcomes (particularly for youth) and public safety.

The Role of Risk Perceptions and Affective Consequences in COVID-19 Protective Behaviors.

BACKGROUND: Slowing the spread of the novel coronavirus (COVID-19) requires behavioral changes such as physical distancing (e.g., staying a 6-foot distance from others, avoiding mass gatherings, reducing houseguests), wearing masks, reducing trips to nonessential business establishments, and increasing hand washing. Like other health behaviors, COVID-19 related behaviors may be related to risk representations. Risk representations are the cognitive responses a person holds about illness risk such as, identity (i.e., label/characteristics of risk), cause (i.e., factors causing condition), timeline (i.e., onset/duration of risk), consequences (i.e., intrapersonal/interpersonal outcomes), behavioral efficacy (i.e., if and how the condition can be controlled/treated), and illness risk coherence (i.e., extent to which representations, behaviors, and beliefs are congruent). The current study applies the Common-Sense Model of Self-Regulation (CSM-SR) to evaluate how risk representations may relate to COVID-19 protective and risk behaviors. METHODS: Participants include 400 workers from Amazon's Mechanical Turk aged ≥ 18 years and US residents. Participants completed an online survey measuring risk representations (B-IPQ) and COVID-19 related behaviors, specifically, physical distancing, hand washing, and shopping frequency. RESULTS: Risk coherence, consequences, timeline, emotional representation, and behavioral efficacy were related to risk and protective behaviors. CONCLUSIONS: Risk representations vary in their relationship to COVID-19 risk and protective behaviors. Implications include the importance of coherent, targeted, consistent health communication, and effective health policy in mitigating the spread of COVID-19.

Smokers Are More Likely to Smoke More after the COVID-19 California Lockdown Order.

To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.

Gender and racial/ethnic differences in adolescent intentions and willingness to smoke cigarettes: Evaluation of a structural equation model.

Dual-process theories may be effective at predicting adolescent smoking; however, little is known about the effectiveness of these models across race/ethnicity and gender. Adolescents (N = 4035) completed biopsychosocial and tobacco-related perception measures in Grade 7 and reported on smoking initiation in Grade 10. Using structural equation modeling and comparing models by gender and race/ethnicity showed differences, where both intentions and willingness predicted smoking initiation for only Black and male adolescents, compared to their Latino and White and female counterparts. Intentions and willingness appear to play a role in whether an adolescent will initiate smoking in the future, but this does not apply universally across gender and race/ethnicity.

Health-Related Issues in Latina Youth: Racial/Ethnic, Gender, and Generational Status Differences.

PURPOSE: Few studies have examined the early development of a broad range of health issues of importance in adolescence in Latina (female) youth, despite their being potentially a vulnerable group. This study compared suicide and depressive symptoms, substance use, violence exposure, injury prevention, obesity, and health-related quality of life among Latina, African-American, and white females as well as Latino (male) youth in fifth grade, as well as differences related to immigrant generational status for Latinas. METHODS: Data were from the Healthy Passages study, including 3,349 African-American, Latina, and white females as well as Latino male fifth graders in three U.S. metropolitan areas. Self-report items and scales were used to compare status on health-related issues. Generational status was classified based on the parent report of birth location. Logistic and linear regression analyses were conducted, including adjustment for sociodemographic differences. RESULTS: Latinas showed higher vulnerability than white females for several health issues, whereas few remained after adjustments for sociodemographic differences (higher obesity, lower bike helmet use, and lower physical health-related quality of life). Latina's lower vulnerability compared with African-American females generally persisted after adjustments. Third generation Latinas, after adjustments, reported lower prevalence of alcohol use and fewer friends using alcohol, yet higher future intentions of alcohol use, than first and second generation Latinas. There were few differences between Latina and Latino youth. CONCLUSIONS: Latina youth generally report low vulnerability across health issues in preadolescence. To the extent they appear at higher vulnerability than white females, this may be related to their disadvantaged sociodemographic status.

Beyond experimentation: Five trajectories of cigarette smoking in a longitudinal sample of youth.

The first goal of this study was to identify the most appropriate measure of cigarette smoking for identifying unique smoking trajectories among adolescents; the second goal was to describe the resulting trajectories and their characteristics. Using 15 annual waves of smoking data in the National Longitudinal Survey of Youth 1997 (NLSY97), we conducted an exploratory latent class growth analysis to determine the best of four outcome variables for yearly smoking (cigarettes per day on days smoked, days smoked per month, mean cigarettes per day, and total cigarettes per month) among individuals aged 12 to 30 (n = 8,791). Days smoked per month was the best outcome variable for identifying unique longitudinal trajectories of smoking and characteristics of these trajectories that could be used to target different types of smokers for prevention and cessation. Objective statistics were used to identify four trajectories in addition to never smokers (34.1%): experimenters (13.6%), quitters (8.1%), early established smokers (39.0%), and late escalators (5.2%). We identified a quitter and late escalator class not identified in the only other comparable latent class growth analysis. Logistic regressions were used to identify the characteristics of individuals in each trajectory. Compared with never smokers, all trajectories except late escalators were less likely to be black; experimenters were more likely to be out of school and unemployed and drink alcohol in adolescence; quitters were more likely to have a mother with a high school degree/GED or higher (versus none) and to use substances in adolescence and less likely to have ever married as a young adult; early established smokers were more likely to have a mother with a high school diploma or GED, be out of school and unemployed, not live with both parents, have used substances, be depressed, and have peers who smoked in adolescence and to have children as young adults and less likely to be Hispanic and to have ever married as young adults; and late escalators were more likely to be Hispanic, drink alcohol, and break rules in adolescence and less likely to have ever married as young adults. Because of the number of waves of data analyzed, this analysis provided a clearer temporal depiction of smoking behavior and more easily distinguishable smoking trajectories than previous analyses. Tobacco control interventions need to move beyond youth-focused approaches to reach all smokers.

Perceived Physical Appearance: Assessing Measurement Equivalence in Black, Latino, and White Adolescents.

Objective: This aim of this study was to examine whether the construct of physical appearance perception differed among the three largest racial/ethnic groups in the United States using an adolescent sample. Methods: Black (46%), Latino (31%), and White (23%) adolescents in Grade 10 from the Healthy Passages study ( N = 4,005) completed the Harter's Self-Perception Profile for Adolescents-Physical Appearance Scale (SPPA-PA) as a measure of physical appearance perception. Results: Overall, Black adolescents had a more positive self-perception of their physical appearance than Latino and White adolescents. However, further analysis using measurement invariance testing revealed that the construct of physical appearance perception, as measured by SPPA-PA, was not comparable across the three racial/ethnic groups in both males and females. Conclusions: These results suggest that observed differences may not reflect true differences in perceptions of physical appearance. Measures that are equivalent across racial/ethnic groups should be developed to ensure more precise measurement and understanding.