Characteristics of Adolescents' and Young Adults' Exposure to and Engagement with Nicotine and Tobacco Product Content on Social Media.

To inform policy and messaging, this study examined characteristics of adolescents' and young adults' (AYAs') exposure to and engagement with nicotine and tobacco product (NTP) social media (SM) content. In this cross-sectional survey study, AYAs aged 13-26 (N=1,163) reported current NTP use, SM use frequency, and exposure to and engagement with SM content promoting and opposing NTP use (i.e. frequency, source[s], format[s], platform[s]). Participants who used NTPs (vs. did not use) were more likely to report having seen NTP content (p-values<.001). Prevalent sources were companies/brands (46.6%) and influencers (44.4%); prevalent formats were video (65.4%) and image (50.7%). Exposure to content promoting NTP use was prevalent on several popular platforms (e.g. TikTok, Instagram, Snapchat); exposure to content opposing NTP use was most prevalent on YouTube (75.8%). Among those reporting content engagement (i.e. liking, commenting on, or sharing NTP content; 34.6%), 57.2% engaged with influencer content. Participants reported engaging with content promoting and opposing NTP use on popular platforms (e.g. TikTok, Instagram, YouTube). Participants with (versus without) current NTP use were significantly more likely to use most SM platforms and to report NTP content exposure and engagement (p-values<.05). Results suggest that NTP education messaging and enforcement of platforms' content restrictions are needed.

An event-based magnetoencephalography study of simulated driving: Establishing a novel paradigm to probe the dynamic interplay of executive and motor function.

Magnetoencephalography (MEG) is particularly well-suited to the study of human motor cortex oscillatory rhythms and motor control. However, the motor tasks studied to date are largely overly simplistic. This study describes a new approach: a novel event-based simulated drive made operational via MEG compatible driving simulator hardware, paired with differential beamformer methods to characterize the neural correlates of realistic, complex motor activity. We scanned 23 healthy individuals aged 16-23 years (mean age = 19.5, SD = 2.5; 18 males and 5 females, all right-handed) who completed a custom-built repeated trials driving scenario. MEG data were recorded with a 275-channel CTF, and a volumetric magnetic resonance imaging scan was used for MEG source localization. To validate this paradigm, we hypothesized that pedal-use would elicit expected modulation of primary motor responses beta-event-related desynchronization (B-ERD) and movement-related gamma synchrony (MRGS). To confirm the added utility of this paradigm, we hypothesized that the driving task could also probe frontal cognitive control responses (specifically, frontal midline theta [FMT]). Three of 23 participants were removed due to excess head motion (>1.5 cm/trial), confirming feasibility. Nonparametric group analysis revealed significant regions of pedal-use related B-ERD activity (at left precentral foot area, as well as bilateral superior parietal lobe: p < .01 corrected), MRGS (at medial precentral gyrus: p < .01 corrected), and FMT band activity sustained around planned braking (at bilateral superior frontal gyrus: p < .01 corrected). This paradigm overcomes the limits of previous efforts by allowing for characterization of the neural correlates of realistic, complex motor activity in terms of brain regions, frequency bands and their dynamic temporal interplay.

Tobacco promotion restriction policies on social media.

Tobacco promotion is prolific on social media, with each platform setting their own restrictions on tobacco promotion and sales. We evaluated the policies related to tobacco product promotion and sales on 11 sites that are popular with youth in May 2021: Discord, Facebook, Instagram, Pinterest, Reddit, Snapchat, TikTok, Tumblr, Twitch, Twitter and YouTube. Nine of the 11 sites prohibited paid advertising for tobacco products. However, only three of them clearly prohibited sponsored content (ie, social influencers) that promotes tobacco. Six platforms restricted content that sells tobacco products and three tried to prohibit underage access to content that promotes or sells tobacco products. Although most platform policies prohibited paid tobacco advertising, few addressed more novel strategies, such as sponsored/influencer content and few had age-gating to prevent youth access. There is a pressing need to regulate tobacco promotion on social media platforms.

The Influence of Health Numeracy and Health Warning Label Type on Smoking Myths and Quit-Related Reactions.

INTRODUCTION: Health numeracy helps individuals understand risk information, but limited data exist concerning numeracy's role in reactions to varying types of health warning labels (HWLs) for cigarettes. METHODS: A nationally representative online panel of adult current smokers received two exposures (1 week apart) to nine HWLs with either text-only or pictorial images with identical mandated text. Following the second exposure, participants (n = 594) rated their beliefs in smoking myths (eg, health-promoting behaviors can undo the risks of smoking) and how much the warnings made them want to quit smoking. Generalized estimating equation regression examined the relation of objective health numeracy and its interaction with HWL type to smoking-myth beliefs and quit-related reactions. RESULTS: Health numeracy was not significantly associated with smoking-myth beliefs; the interaction with HWL type was also nonsignificant. Adult smokers with lower health numeracy had higher quit-related reactions than those with higher numeracy following exposure to HWLs. The type of HWL significantly modified numeracy's associations with quit-related reactions; no significant association existed between text-only HWLs and quit-related reactions, whereas among those who viewed the pictorial warnings, lower numeracy was associated with greater quit-related reactions (ß = -.23; p < .001). CONCLUSIONS: Lower as compared to higher health numeracy was significantly associated with higher quit-related reactions to HWLs and especially with pictorial HWLs. Health numeracy and HWL type were not associated with the endorsement of smoking myths. The role of health numeracy in effectively communicating risks to smokers warrants thoughtful consideration in the development of tobacco HWLs. IMPLICATIONS: Health numeracy plays an important role in an individual's ability to understand and respond to health risks. Smokers with lower health numeracy had greater quit-related reactions to pictorial health warnings than those who viewed text-only warning labels. Development and testing of health warning labels should consider health numeracy to most effectively communicate risk to US smokers.

Emotional graphic cigarette warning labels reduce the electrophysiological brain response to smoking cues.

There is an ongoing public debate about the new graphic warning labels (GWLs) that the Food and Drug Administration (FDA) proposes to place on cigarette packs. Tobacco companies argued that the strongly emotional images FDA proposed to include in the GWLs encroached on their constitutional rights. The court ruled that FDA did not provide sufficient scientific evidence of compelling public interest in such encroachment. This study's objectives were to examine the effects of the GWLs on the electrophysiological and behavioral correlates of smoking addiction and to determine whether labels rated higher on the emotional reaction (ER) scale are associated with greater effects. We studied 25 non-treatment-seeking smokers. Event-related potentials (ERPs) were recorded while participants viewed a random sequence of paired images, in which visual smoking (Cues) or non-smoking (non-Cues) images were preceded by GWLs or neutral images. Participants reported their cigarette craving after viewing each pair. Dependent variables were magnitude of P300 ERPs and self-reported cigarette craving in response to Cues. We found that subjective craving response to Cues was significantly reduced by preceding GWLs, whereas the P300 amplitude response to Cues was reduced only by preceding GWLs rated high on the ER scale. In conclusion, our study provides experimental neuroscience evidence that weighs in on the ongoing public and legal debate about how to balance the constitutional and public health aspects of the FDA-proposed GWLs. The high toll of smoking-related illness and death adds urgency to the debate and prompts consideration of our findings while longitudinal studies of GWLs are underway.

Content matters: neuroimaging investigation of brain and behavioral impact of televised anti-tobacco public service announcements.

Televised public service announcements are video ads that are a key component of public health campaigns against smoking. Understanding the neurophysiological correlates of anti-tobacco ads is an important step toward novel objective methods of their evaluation and design. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the brain and behavioral effects of the interaction between content ("argument strength," AS) and format ("message sensation value," MSV) of anti-smoking ads in humans. Seventy-one nontreatment-seeking smokers viewed a sequence of 16 high or 16 low AS ads during an fMRI scan. Dependent variables were brain fMRI signal, the immediate recall of the ads, the immediate change in intentions to quit smoking, and the urine levels of a major nicotine metabolite cotinine at a 1 month follow-up. Whole-brain ANOVA revealed that AS and MSV interacted in the inferior frontal, inferior parietal, and fusiform gyri; the precuneus; and the dorsomedial prefrontal cortex (dMPFC). Regression analysis showed that the activation in the dMPFC predicted the urine cotinine levels 1 month later. These results characterize the key brain regions engaged in the processing of persuasive communications and suggest that brain fMRI response to anti-smoking ads could predict subsequent smoking severity in nontreatment-seeking smokers. Our findings demonstrate the importance of the quality of content for objective ad outcomes and suggest that fMRI investigation may aid the prerelease evaluation of televised public health ads.

Beliefs associated with intention to ban smoking in households with smokers.

INTRODUCTION: Smoking in homes exposes family members to secondhand smoke, an exposure that is harmful to children and adults. This study identifies barriers to instituting household smoking bans and beliefs that are positively and negatively related to smoking bans in households with smokers. METHODS: A telephone survey of parents living in Philadelphia with at least 1 smoker and a child under the age of 13 years in the household was conducted in 2012. Using the reasoned action model, the survey assessed beliefs regarding attitudes, norms, and self-efficacy/control predictors of intention to ban household smoking. RESULTS: Forty-seven percent of households reported high intention to not allow smoking in the home. Regression analysis to identify the reasoned action predictors associated with intention to restrict smoking in the home showed that all 3 of the predictors of intention (attitude, normative pressure, and control) were significantly related to intention. Important underlying beliefs related to intention included beliefs about the health effects of secondhand smoke on children's health, norms regarding those restrictions, and barriers to enforcing such restrictions. CONCLUSIONS: Messages that increase concern about the health effects of secondhand smoke on children, that contrast the rights of smokers with negative health effects, and that suggest alternative locations to smoke are promising strategies to motivate smokers to implement indoor smoking bans.

Media Influences on Children and Advice for Parents to Reduce Harmful Exposure to Firearm Violence in Media.

Firearm violence is now the leading cause of youth fatalities in the United States. This article outlines the various ways that entertainment media glorify the use of firearms and how this content can influence youth interest and use of guns. Social media are also increasingly serving as a source of risk for exposure to firearms. Counseling parents about the impact of media exposure to firearms on their children's health, and how to mitigate these risks, can be effective in promoting their children's health and safety.

Predicting cigarette use initiation and dependence in adolescence using an affect-driven exploration model.

Adolescent decisions, especially in novel contexts, are often guided by affective evaluations (i.e., feelings associated with a stimulus) rather than knowledge of the risks and probabilities of different outcomes. In this study, we used the affect-driven exploration (ADE) model to illustrate how affective evaluations can play a critical role in driving early use of cigarettes, as well as the adaptive function of the resulting experiential learning in informing future affect and cigarette use. We analyzed five waves of data collected from a large, diverse community sample of adolescents who were followed from early to late adolescence (N = 386; 50.9% female; Baseline age = 11.41 ± 0.88 years) during years 2004-2010 to model trajectories of positive affect and risk perceptions (associated with cigarette use) and examined the associations of these trajectories with their self-reported cigarette use and dependence symptoms. Consistent with the ADE model, early initiators reported higher levels of positive affect at baseline, which we argue may have led them to try cigarettes. Notably, most early initiators reported a decline in positive affect over time, suggesting an experience-based shift in affective evaluations associated with cigarette use. Risk perceptions associated with cigarette use did not emerge as a significant predictor of cigarette use or subsequent dependence. Therefore, for deterring adolescent cigarette use, efforts to influence affect (through graphic warning labels and other media) may be more effective than directly influencing risk perceptions. Despite the affective basis for initiating cigarette use, few adolescents engaged in early use (N = 20) or developed symptoms of dependence (N = 25). Majority of those who engaged in early cigarette use showed a decline in positive affect, with corresponding increase in risk perceptions over time. Some early users may indeed continue to engage in cigarette use, but this is likely driven by the addictive properties of the drug. Overall these findings challenge the popular stereotype of impulsive and emotionally reactive behaviors during adolescence, and suggest a more nuanced interpretation of adolescent risk behavior.

Rethinking Cell Phone Use While Driving: Isolated Risk Behavior or a Pattern of Risk-Taking Associated with Impulsivity in Young Drivers?

This study examines whether cell phone use stands apart from a general pattern of risky driving practices associated with crashes and impulsivity-related personality traits in young drivers. A retrospective online survey study recruited 384 young drivers from across the United States using Amazon's Mechanical Turk to complete a survey measuring risky driving practices (including cell phone use), history of crashes, and impulsivity-related personality traits. Almost half (44.5%) of the drivers reported being involved in at least one crash, and the majority engaged in cell phone use while driving (up to 73%). Factor analysis and structural equation modeling found that cell phone use loaded highly on a latent factor with other risky driving practices that were associated with prior crashes (b = 0.15, [95% CI: 0.01, 0.29]). There was also an indirect relationship between one form of impulsivity and crashes through risky driving (b = 0.127, [95% CI: 0.01, 0.30]). Additional analyses did not find an independent contribution to crashes for frequent cell phone use. These results suggest a pattern of risky driving practices associated with impulsivity in young drivers, indicating the benefit of exploring a more comprehensive safe driving strategy that includes the avoidance of cell phone use as well as other risky practices, particularly for young drivers with greater impulsive tendencies.

Trends in US movie tobacco portrayal since 1950: a historical analysis.

OBJECTIVE: Portrayal of tobacco use in films has been causally linked to youth smoking initiation. However, findings regarding trends in portrayal in US films since 1950 are inconsistent, potentially due to differences in sampling densities, intercoder reliabilities and time periods covered. The present study was designed to overcome these inconsistencies with a common sampling frame and methodology. METHODS: A half sample of the 30 top-grossing US films per year from 1950 to 2006 (N=855) was coded in 5-min segments for total tobacco-related content and main character tobacco use. Film tobacco trends were identified using linear regression and compared to national per capita cigarette consumption and historically significant tobacco control events. RESULTS: Tobacco content declined considerably since 1950. Total tobacco-related content peaked around 1961, while the decline in portrayal of main character use was already underway in 1950. Cigarette consumption peaked around 1966 with a trend that closely paralleled total tobacco content and that coincided with major tobacco control events. CONCLUSIONS: This study, which had high reliability, dense sampling and covered a long time period, indicates that tobacco content has declined in top-ranked US movies since 1950 with a trend in total tobacco content that closely paralleled the drop in per capita cigarette consumption and the increase in significant tobacco control efforts. Despite the inability to draw causal conclusions, tobacco portrayal in films may serve as barometer of societal support for the habit and thus efforts should continue to limit exposure to such content.

Teen driver crash risk and associations with smoking and drowsy driving.

Motor vehicle crashes are the leading cause of death for young people in the United States. The goal of this study was to identify risk factor profiles of teen and young adult drivers involved in crashes. General demographic and behavioral as well as driving-related factors were considered. Analysis of a nationally representative telephone survey of U.S. young drivers ages 14 to 22 (N=900) conducted in 2005 was restricted to 506 licensed drivers (learners excluded). Statistically significant univariate associations between factors of interest and the primary outcome, crash involvement (ever) as a driver, were identified and included within a multivariate logistic regression model, controlling for potential demographic confounders. Aside from length of licensure, only driving alone while drowsy and being a current smoker were associated with having been in a crash. Gaining a better understanding of these behaviors could enhance the development of more customized interventions for new drivers.

Associations between smoking and depression in adolescence: an integrative review.

BACKGROUND: Although research has established the existence of an association between smoking and depression among adolescents, researchers have not reached consensus on the nature of the association. OBJECTIVES: The purpose of this paper is to review the literature, to examine the nature of the relationship between smoking and depression in adolescence, and to suggest future research directions. METHOD: A literature search was conducted from the following six databases: (a) Ovid MEDLINE, (b) CINAHL, (c) PubMed Unrestricted, (d) PsycINFO, (e) ERIC, and (f) Sociological Abstracts. The combinations of the words, "depression," "smoking," "tobacco," "adolescent," and "teen" were used for keyword searches to find relevant articles. RESULTS: In 47 of 57 studies, significant associations between smoking and depression were found. However, these significant relationships may either be spurious or unrelated to depression because a substantial number of studies did not adjust for confounders or did not use validated instruments to measure depression. Additionally, if the relationship is causal, its direction remains controversial. Five relationships have been suggested: (a) Depression causes smoking, (b) smoking causes depression, (c) there is a bidirectional relationship between smoking and depression, (d) smoking and depression occur due to confounders, and (e) subgroups with different relationships between the two conditions exist. CONCLUSIONS: It is necessary to further explore the relationship between smoking and depression. Future research should consider the need for: (a) longitudinal research designs, (b) more accurate measurement of depression, and (c) the control of confounders between smoking and depression.

Digital Media and Risks for Adolescent Substance Abuse and Problematic Gambling.

Digital media provide increased opportunities for both marketing and social transmission of risky products and behavior. We briefly review what is known about adolescent exposure to favorable presentations of addictive substances, such as alcohol, tobacco, and marijuana, as well as behaviors such as gambling, on social and other online media. Our understanding of these influences and whether they require greater regulation is still developing, and recommendations for future research to address these gaps in our understanding are described. Potential strategies to intervene in these environments to protect adolescents and young adults from the adverse effects of these products are described, as well as future challenges for developing interventions.

Working memory ability predicts trajectories of early alcohol use in adolescents: the mediational role of impulsivity.

AIMS: (i) To evaluate the role of pre-existing weakness in working memory ability (WM) as a risk factor for early alcohol use as mediated by different forms of impulsivity and (ii) to assess the adverse effects of progressive alcohol use on variations in WM over time. DESIGN, SETTING AND PARTICIPANTS: A community sample of 358 adolescents [48% males, mean(age) (baseline) = 11.4 ± 0.87 years] from a longitudinal cohort design, assessed annually over 4 consecutive years with less than 6% attrition. MEASUREMENTS: Repeated assessments were conducted for the following key variables: WM (based on performance on four separate tasks), frequency of alcohol use (AU) and three forms of impulsivity, namely sensation seeking (SS), acting without thinking (AWT) and delay discounting (DD). Latent growth curve modeling procedures were used to identify individual trajectories of change for all key variables. FINDINGS: Weakness in WM (at baseline) predicted significantly both concurrent alcohol use and increased frequency of use over the four waves (P < 0.05). This effect was entirely mediated by two forms of impulsivity, AWT and DD, both of which were characterized by underlying weakness in WM. No individual variation was observed in the slopes of WM, which suggests that individual variations in alcohol use were not associated with changes in WM in our early adolescent sample. CONCLUSIONS: Early adolescent alcohol use may be a consequence of (pre-existing) weaknesses in working memory (WM) rather than a cause of it. Efforts to reduce early alcohol use should consider the distinct roles of different impulsivity dimensions, in addition to WM, as potential targets of intervention.

Trends in explicit portrayal of suicidal behavior in popular U.S. movies, 1950-2006.

Trends in suicidal behavior portrayal in movies may reflect greater societal acceptance of suicide with potential adverse effects on adolescents. To assess the potential for such adverse effects, explicit portrayals of suicidal behavior and the ratings of films were coded in top-grossing U.S. movies from 1950-2006 (N = 855). Suicidal behavior portrayal in films increased linearly from 1950 to 2006. From 1968-1984, movies rated R by the Motion Picture Association of America had 5 times more highly explicit suicide behavior portrayals than did G/PG films. After the adoption of the PG-13 category in 1985, PG-13 and R films were indistinguishable on this measure. The results indicate the need for further study of the effects of suicidal behavior portrayals on adolescent movie audiences.

Unrealistic fatalism in U.S. youth ages 14 to 22: prevalence and characteristics.

PURPOSE: To estimate the proportion of U.S. youth that exhibits unrealistic fatalism about its future (not expecting to live past age 30), and to test predictions about risk factors for this expectation. METHODS: Four waves of a nationally representative telephone survey from 2002 to 2005 with youth ages 14 to 22 (N = 4201) were analyzed using logistic regression to identify correlates and predictors of unrealistic fatalism. RESULTS: Approximately 1 out of every 15 youth interviewed (6.7%, 95% confidence interval [CI] = 5.9%, 7.5%) responded that they agreed they would not live much past the age of 30. Compared to other youth, fatalists were significantly more likely to be older, male, to identify as Hispanic, and have completed the interview in Spanish. As predicted, recent experience of hopelessness was a strong predictor of fatalism. In addition, nonwhite youth who had experienced hopelessness reported increasing rates of fatalism as they aged. Fatalistic youth engaged in greater suicidal planning, had more accepting attitudes toward suicide, were less attached to religion, and were more impulsive than other youth. Approximately 43% of fatalists forecast a likely death by suicide, whereas the rest anticipated death by an outside source. Fatalists were also more likely not to stay in school. CONCLUSIONS: Because youth exhibiting fatalism are at risk for not staying in school and suicidal planning, they should be identified at an early age for referral to programs that are effective in treating youth with hopelessness and suicidal tendencies.

The role of parents' health in their offspring's intentions to quit smoking.

BACKGROUND: Motivating cessation among young smokers is an important challenge for smoking reduction programs. This research examines the role of perceived illness in smoking parents as a motivator for cessation in young smokers. METHODS: Two nationally representative samples of young U.S. smokers (ages 14 to 22 and 18 to 25 in 2002) assessed perceptions of parent health, quit intentions, risk perceptions and affective expectations for smoking to test the hypothesis that perceived illness in smoking parents motivates quitting by linking unfavorable emotional reactions to the smoking experience. RESULTS: Approximately 88% of young smokers reported that parents who smoked were in less than very good health compared to 54% of smokers whose parents did not smoke. Unlike young smokers whose parents did not smoke, the quit intentions of those whose parents smoked were directly related to the perceived ill health of their parents. Affective expectations rather than perceived risk of smoking appeared to mediate these relations. CONCLUSION: Youth smoking cessation programs could benefit from targeting smokers whose parents smoke and are likely to show the long-term effects of smoking-related illness.