Identifying message themes to prevent e-cigarette use among youth and young adults.

In 2020, almost 20% of high school students reported current e-cigarette use. Mass media tobacco prevention campaigns are effective for preventing tobacco use among youth and young adults but selecting messages that will have maximum impact on the target audience is a significant challenge for campaign developers. This study describes the method for identification of potential messaging targets for a national anti-vape mass media campaign using criteria proposed by Hornik and Woolf in their health communication framework. A national sample of 15- to 24-year-olds (N = 1564) was recruited via an online panel in May 2020. Participants endorsed a series of vape-related attitudinal items. Items were considered potential message targets if they distinguished between the four vape use groups (current users, ever users, susceptible never-users, and non-susceptible never-users) and if less than 70% of respondents endorsed the anti-vape item response. The resulting items targeted five potential message themes, each forming a scale measured with three to four individual items. Message themes included social acceptability of vaping, anti-vape industry sentiment, independence from vaping, non-vaping identity, and perceived risk of harm. Findings were used to inform the development of truth® campaign messaging focused on reducing the prevalence of e-cigarette use among youth and young adults.

Vaping in the Workplace: Awareness and Support for E-cigarette Workplace Policies.

Objectives: Clean indoor air policies have been an important tool protecting the health of working adults. The purpose of this study was to examine awareness of and support for e-cigarette-free workplace policies among working adults in the United States. Methods: Employees of companies with at least 150 employees (N = 1607, ages 18-65 years) were recruited from an opt-in national panel for an online survey. Results: Nearly half of respondents (48.4%) reported that their employer had a written policy addressing e-cigarette use, 30.2% reported their employer did not have such a policy, and 21.4% reported that they did not know. Most respondents (73.5%) supported e-cigarette-free workplaces, including the majority of current e-cigarette users (53.5%). Multiple regression modeling found that odds of support for e-cigarette workplace policies was significantly higher among never (OR = 1.77, 95% CI: 1.19-2.64) and former e-cigarette users (OR = 1.71, 95% CI: 1.15-2.54) relative to current users. Policy support also varied by perceived harm and other perceptions of workplace vaping, and demographic and workplace characteristics. Conclusions: E-cigarette-free workplace policies have high levels of support among employees, including both current and former e-cigarette users. Policies restricting workplace vaping can improve the health of all employees.

Vaping in the Workplace: Prevalence and Attitudes Among Employed US Adults.

OBJECTIVE: Describe workplace vaping, prevalence of observed use, attitudes, and perceptions among US adults. METHODS: Employees of companies with more than 150 employees, drawn from an opt-in national online panel (N = 1607), ages 18 to 65, completed an online survey in November 2019. RESULTS: Majority (61.6%) observed coworkers vaping at work and 19.1% reported vaping at work themselves. Participants perceived workplace vaping as moderately harmful (M = 1.9 out of 3), 63.2% were bothered by workplace vaping and 52.1% thought it decreased workplace productivity among non-users. Multiple regression models found workplace vaping prevalence varied by industry and participant characteristics, and attitudes about it varied by tobacco use status. CONCLUSIONS: Workplace vaping and vaping exposure is common in US workplaces. Employees, particularly non-users, hold generally negative perceptions of workplace vaping. Comprehensive policies to prevent workplace vaping are needed to protect workers.

Effects of Multiple Exposures and Ad-Skipping Behavior on Recall of Health Messages on YouTubeTM.

Although measuring exposure to public health messages is key to understanding campaign effectiveness, little is known about how exposure to and avoidance of digital ad messages may influence self-reported ad recall. A sample of 15-24-year-olds (n = 297) received a varying number of forced-view and skippable test ads across multiple simulated YouTubeTM sessions. Each session was coded for whether the participant viewed the ad or skipped it. While a majority of participants recalled the test ad, the odds of ad recall did not vary by number of sessions (opportunities for exposure). Rather, ad recall was sensitive to the number of completed ad views such that odds of ad recall doubled for each additional time the ad was completely viewed. Findings suggest that public health digital message exposure and recall can be optimized with sufficient attention paid to the proportions of forced-view ads aired when aiming to reach younger audiences.

Vaping in the Workplace: Implications for Employer-Sponsored Tobacco Cessation Programs.

OBJECTIVE: Assess workplace vaping as a trigger for tobacco use; examine interest in and prevalence of vaping cessation programs; determine needs of parents whose children vape. METHODS: Employees of companies with more than 150 employees, drawn from an opt-in national online panel (N = 1607), ages 18 to 65, completed an online survey in November 2019. RESULTS: Among tobacco users, 46% to 48% reported workplace vaping was a trigger for smoking and vaping, respectively; 7% of former users reported it as a trigger. Quit vaping support is important to 85% of employees; 1/3 of workplaces have such programs, with industry variation. Child vaping results in presenteeism and absenteeism among roughly 1/3 of parents. CONCLUSIONS: Workplace vaping is a trigger for smoking and vaping among current and former tobacco users. A gap exists between desired support for vaping cessation and current employer-sponsored cessation programs.

Using Aggregate Temporal Variation in Ad Awareness to Assess the Effects of the truth® Campaign on Youth and Young Adult Smoking Behavior.

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation.

Validating Self-Reported Ad Recall as a Measure of Exposure to Digital Advertising: An Exploratory Analysis Using Ad Tracking Methodology.

Many mass media campaigns aimed at changing young people's health behavior air on digital platforms rather than on broadcast media (e.g., television), given the intended audience's preference for web-based communication. While research suggests self-reported ad recall correlates with exposure to television advertising, it remains unclear whether self-report measures are correlated with exposure to digital advertising. This study examined the association between an objective measure of digital ad exposure and self-reported recall of digital ads from the truth® tobacco prevention campaign. Digital ad tracking methodology was employed to identify members of an online panel (ages 18-34) who had been exposed to ads during their regular web browsing. Demographics of exposed participants were used to develop a matched control group of non-exposed panel members. Members of the Exposed group (n = 458) and matched Control participants (n = 506) were surveyed on recall of truth ads, media use, and demographics. Results indicated that Exposed participants had significantly higher odds of reporting ad recall compared to Control participants. With each additional ad exposure, the odds of self-reporting higher frequency of ad exposure increased by 8% (OR = 1.08, 95% CI = 1.01-1.16). Findings suggest self-reported measures of ad recall are a valid measure of campaign exposure in a digital media environment.

The availability of retail tobacco near federally qualified healthcare facilities and addiction treatment centers in New York State.

The effectiveness of tobacco control policies that create smoke-free healthcare facilities and encourage the delivery of tobacco dependence treatment may be undermined by the availability of retail tobacco in the surrounding environments. This study examined the availability of retail tobacco in relation to: federally qualified health centers and look-a-like (FQHC/LAL) healthcare facilities (n = 706) as well as substance abuse and addiction treatment centers (n = 953) across New York State (NYS) in 2018. A statewide tobacco retailer density surface using static-bandwidth kernel density estimation was constructed from geocoded licensed tobacco vendors (n = 21,314). For each healthcare facility, tobacco retailer density (retailers per square mile) was extracted from the underlying NYS density surface. Proximity from each healthcare facility to the nearest tobacco vendor was calculated in walkable miles. Across NYS, tobacco retailer density ranged from 0 to 41.02 retailers per square mile. The availability of retailer tobacco near FQHC/LAL healthcare facilities and substance abuse and addiction treatment centers was higher in metropolitan areas than less urban areas as expected. School-based FQHC/LAL healthcare facilities had higher density than all other FQHC/LAL healthcare facilities types (Mean = 20.82 vs. 17.04, p = 0.0042), while opioid abuse and addiction treatment centers had on average higher density (Mean = 20.42 vs. 9.81, p < 0.0001) and closer proximity to a tobacco vendor (Mean = 0.14 vs. 0.36, p < 0.0001) than other substance abuse and addiction treatment centers. State and local tobacco control retailer reduction policies should be considered to reduce the availability of retail tobacco surrounding these facilities.

Young Adult Tobacco and E-cigarette Use Transitions: Examining Stability Using Multistate Modeling.

INTRODUCTION: The objective of this study was to describe tobacco and nicotine product use state transition probabilities among youth and young adults over time. METHODS: A national sample of young adult tobacco product users and nonusers between the ages of 18 and 34 years at baseline was surveyed at 6-month intervals for 3 years. Use and nonuse states were defined as mutually exclusive categories based on self-reported, past 30-day use of the various products. Never use, noncurrent use, and current use of combustible, noncombustible tobacco, and electronic cigarette (e-cigarette) products was assessed at each interval. A multistate model was fit to estimate transition probabilities between states and length of stay within each state. RESULTS: After 6 months, same-state transition probabilities were high for all use states (0.76-0.96), except for dual product use (0.48). After 3 years, transition probabilities were smaller and tended to converge toward combustible product use for baseline e-cigarette (0.42), combustible (0.51), and dual product users (0.52). Age was inversely associated with transition risk from never or noncurrent use to use of combustible or e-cigarette products. CONCLUSIONS: Never and noncurrent users, followed by combustible product users, were most likely to remain in those states throughout the 3-year observation interval. Users of any tobacco or e-cigarette product at baseline were most likely to transition to combustible product use or noncurrent use by the final follow-up. IMPLICATIONS: This study describes the probability of transitioning between various states of tobacco product use, including never and no current use, over a span of 3 years in a sample of young adults. This type of longitudinal description, which includes all tobacco product use states, is lacking in most studies that tend to focus on one or only a few products. The results suggest that it is important to assess outcomes over a sufficiently long period to capture true variability in patterns of product use.

Cost-Effectiveness of Using Mass Media to Prevent Tobacco Use among Youth and Young Adults: The FinishIt Campaign.

Mass media campaigns have been hailed as some of the most effective tobacco prevention interventions. This study examined the cost-effectiveness of the national tobacco prevention campaign, truth® FinishIt, to determine the cost per quality-adjusted life year (QALY) saved and the return on investment (ROI). The cost-utility analysis used four main parameters: program costs, number of smoking careers averted, treatment costs, and number of QALYs saved whenever a smoking career is averted. Parameters were varied to characterize cost-effectiveness under different assumptions (base case, conservative, optimistic, and most optimistic). The ROI estimate compared campaign expenditures to the cost saved due to the campaign implementation. Analyses were conducted in 2019. The base case analysis indicated the campaign results in a societal cost savings of $3.072 billion. Under the most conservative assumptions, estimates indicated the campaign was highly cost-effective at $1076 per QALY saved. The overall ROI estimate was $174 ($144 in costs to smokers, $24 in costs to the smoker's family, and $7 in costs to society) in cost savings for every $1 spent on the campaign. In all analyses, the FinishIt campaign was found to reach or exceed the threshold levels of cost savings or cost-effectiveness, with a positive ROI. These findings point to the value of this important investment in the health of the younger generation.

Cigarette smoking, prescription opioid use and misuse among young adults: An exploratory analysis.

Young adults have the highest prevalence of misuse of prescription opioids. In 2016, 7.1% of 18- to 25-year-olds reported misuse, meaning use other than as prescribed. While smoking is known to be associated with opioid use, to our knowledge no study has examined the relationships between smoking, prescribed use of opioids, and opioid misuse in young adults at the population level. Online survey data were collected in spring 2018 from a nationally representative sample of 18-25-year-olds from the Truth Longitudinal Cohort (N = 10,502). Respondents self-reported cigarette smoking, and both lifetime and recent (past 6-month) prescribed use and misuse of opioids. Generalized ordered logistic regression modeling was used to determine associations between cigarette smoking and recent prescribed use and misuse while controlling for demographic characteristics, other substance use, sensation seeking, and mental health status. Overall, 61.0% of respondents reported lifetime prescribed use of opioids and 16% reported recent prescribed use. Lifetime misuse was reported by 19.4%, with 7.8% reporting recent misuse. Together, the models revealed a graded relationship, with current smokers having higher odds of both prescribed use and misuse, never smokers having lowest odds of use or misuse, and ever smokers, those who had smoked but not in the past 30 days, falling between current and never smokers. Findings indicate a clear association between smoking and use of opioids even after accounting for a strong association between prescribed use and misuse among young adults.

Patterns of nicotine concentrations in electronic cigarettes sold in the United States, 2013-2018.

INTRODUCTION: Considerable declines in cigarette smoking have occurred in the U.S. over the past half century. Yet emerging tobacco products, including e-cigarettes, have increased in popularity among U.S. youth and adults in recent years. Nicotine content is an important factor in weighing the potential benefits and risks of e-cigarettes on individual and population level health. This study examined how nicotine concentrations of e-cigarette products sold have changed from 2013 to 2018. METHODS: E-cigarette sales data aggregated in 4-week periods from March 2, 2013 to September 8, 2018 (66 months total) from convenience store and mass market channels were obtained from Nielsen. Internet and vape shop sales were not available. Internet searches were used to supplement information for nicotine concentration and flavor. Products were categorized by nicotine concentration, flavor, type (disposable or rechargeable), and brand. Dollar sales, unit sales, and average nicotine concentration were assessed. RESULTS: During 2013-2018, the average nicotine concentration in e-cigarettes sold increased overall, for all flavor categories, and for rechargeable e-cigarettes. The proportion of total dollar sales comprised of higher nicotine concentration e-cigarettes (>4% mg/mL) increased from 12.3% to 74.7% during 2013-2018, with a similar increase in unit share. Zero-nicotine products accounted for less than 1% of dollar market share across all years analyzed. CONCLUSIONS: E-cigarettes with higher nicotine concentrations comprise a substantial and increasing portion of U.S. e-cigarette sales. Higher nicotine concentrations may influence patterns of e-cigarette use, including harms from e-cigarette initiation among youth and potential health benefits for adult smokers switching completely to e-cigarettes.

Young Adults' Opioid Prescription History and Opioid Misuse Perceptions.

Objectives: In this study, we investigated perceptions of prescription opioid misuse among young adults who had or had not been prescribed opioids in the past. Methods: Participants from a national online panel, age 18-34 (N = 1220), completed a survey about their medical use of opioids and their perceptions of the risks and prevalence of opioid misuse and dependence. Associations between prescription history and perceptions of opioids were tested using generalized ordered logistic models. Results:Most respondents reported receiving at least one prescription for opioids in their lifetime (68%), with 57% reporting past-year prescriptions. Re spondents with more lifetime prescriptions perceived higher rates of misuse and dependence. More lifetime prescriptions were associated with lower perceived risk of occasional prescription opioid misuse but higher perceived risk for regular misuse. Conclusions: Prior experience with receiving a prescription for opioid pain relievers is associated with young adults' perceptions of opioid misuse. Taking prescription opioids, even as directed, provides young adults with expo- sure to the drugs that may shape these perceptions both by increasing awareness of the drug and through exposure to misuse of the drug.

Longitudinal Tobacco Use Transitions Among Adolescents and Young Adults: 2014-2016.

INTRODUCTION: Among youth, the frequency and prevalence of using more than one tobacco (small cigar, cigarette, and hookah) or nicotine-containing product (e-cigarettes-ENDS) are changing. These shifts pose challenges for regulation, intervention, and prevention campaigns because of scant longitudinal data on the stability of use patterns in this changing product landscape. METHODS: A nationally representative longitudinal survey of 15- to 21-year olds (n = 15,275) was used to describe transitions between never use, noncurrent use, and past 30-day use of combustible tobacco, e-cigarettes (ENDS), and dual use of both kinds of products. A multistate model was fit to observations collected every 6 months across 2.5 years to estimate the probability of transitions between states (TPs), the average time in state (sojourn time), and the effect of age on transitions. RESULTS: Current state strongly predicted future state over time intervals of 1 year or less, but only weakly predicted future state at longer intervals: TP to noncurrent use was higher for ENDS-only than combustible-only users over a 6-month interval but was similar for both groups over a 2-year interval. Sojourn time was significantly longer for combustible-only (0.52 years) and dual use (0.55 years) than ENDS-only use (0.27 years); older youth were more likely than younger youth to stay combustible tobacco users or noncurrent users. CONCLUSIONS: The dynamics of transitions between combustible tobacco products and ENDS in a population of youth and young adults suggest that policy and prevention efforts must consider the frequent changes and instability over a 1-year or less time period in use patterns among young people. IMPLICATIONS: The study addresses an urgent need in public health for timely information on how youth and young adults use tobacco and nicotine products. We found that youth, particularly adolescents, moved frequently between using ENDS and combustible tobacco products either alone or together. Importantly, the utility of current-use states for predicting future use states declined for time horizons longer than 1 year. Our results demonstrate a need for caution in interpreting product transitions. Longitudinal data with frequent observations and coverage of a wide range of possible product types is required to fully characterize usage patterns in youth.

Estimating the Pathways of an Antitobacco Campaign.

PURPOSE: This study examined mechanisms through which the truth campaign, a national mass media antismoking campaign, influences smoking-related attitudes, and progression of tobacco use over time in youth and young adults. METHODS: Structural equation modeling tested causal pathways derived from formative research and behavioral theory with a nationally representative longitudinal sample of 15-21-year-olds (n = 8747) over 24 months. Data were collected from 2014 to 2016, and analyses were conducted in 2017. RESULTS: Greater ad awareness predicted strengthening of attitudes targeted by the campaign (i.e., feelings of independence from tobacco, antitobacco industry sentiment, decreasing acceptance of social smoking, and decreasing acceptance of smoking imagery), and attitude changes were significantly associated with greater support for an antitobacco social movement (e.g., agreement to the item "I would be part of a movement to end smoking"). Greater social movement support predicted a slower rate of progression on smoking intensity after two years of the campaign. CONCLUSIONS: Findings suggest that engaging youth and young adults in a cause-based social movement for promoting health can be a powerful strategy to drive positive behavior change. Messages targeting attitudes that resonate with values important to this age group, including independence and connectedness, are particularly effective. Investments in national antitobacco public education campaigns are key policy interventions which continue to help prevent tobacco use among youth and young adults.

Individual differences in nonverbal prediction and vocabulary size in infancy.

Children who generate and update verbal predictions have larger vocabularies, suggesting that prediction may be a mechanism that supports language learning. We hypothesize that this relation is not confined to the domain of language, but instead signals a broader individual difference in information processing. To investigate this possibility, we tested infants (n = 50) in the early stages of vocabulary development (12-24 months) on their ability to generate and update nonverbal, visual predictions. In an eye-tracking task, a central fixation reliably preceded a peripheral target. Then, halfway through the experiment, the peripheral target began appearing on the opposite side. We assessed infants' proficiency in initiating anticipatory eye movements before and after the switch, and found that infants with larger vocabularies did not generate more predictions overall, but were more efficient in updating predictions to the new target side. These findings establish a link between nonverbal prediction and vocabulary in infancy, and suggest a promising means of addressing whether or not prediction abilities are causally related to language learning.

Infants segment continuous events using transitional probabilities.

Throughout their 1st year, infants adeptly detect statistical structure in their environment. However, little is known about whether statistical learning is a primary mechanism for event segmentation. This study directly tests whether statistical learning alone is sufficient to segment continuous events. Twenty-eight 7- to 9-month-old infants viewed a sequence of continuous actions performed by a novel agent in which there were no transitional movements that could have constrained the possible upcoming actions. At test, infants distinguished statistically intact units from less predictable ones. The ability to segment events using statistical structure may help infants discover other cues to event boundaries, such as intentions, and carve up the world of continuous motion in meaningful ways.

All together now: concurrent learning of multiple structures in an artificial language.

Natural languages contain many layers of sequential structure, from the distribution of phonemes within words to the distribution of phrases within utterances. However, most research modeling language acquisition using artificial languages has focused on only one type of distributional structure at a time. In two experiments, we investigated adult learning of an artificial language that contains dependencies between both adjacent and non-adjacent words. We found that learners rapidly acquired both types of regularities and that the strength of the adjacent statistics influenced learning of both adjacent and non-adjacent dependencies. Additionally, though accuracy was similar for both types of structure, participants' knowledge of the deterministic non-adjacent dependencies was more explicit than their knowledge of the probabilistic adjacent dependencies. The results are discussed in the context of current theories of statistical learning and language acquisition.

Expectancy learning from probabilistic input by infants.

Across the first few years of life, infants readily extract many kinds of regularities from their environment, and this ability is thought to be central to development in a number of domains. Numerous studies have documented infants' ability to recognize deterministic sequential patterns. However, little is known about the processes infants use to build and update representations of structure in time, and how infants represent patterns that are not completely predictable. The present study investigated how infants' expectations fora simple structure develope over time, and how infants update their representations with new information. We measured 12-month-old infants' anticipatory eye movements to targets that appeared in one of two possible locations. During the initial phase of the experiment, infants either saw targets that appeared consistently in the same location (Deterministic condition) or probabilistically in either location, with one side more frequent than the other (Probabilistic condition). After this initial divergent experience, both groups saw the same sequence of trials for the rest of the experiment. The results show that infants readily learn from both deterministic and probabilistic input, with infants in both conditions reliably predicting the most likely target location by the end of the experiment. Local context had a large influence on behavior: infants adjusted their predictions to reflect changes in the target location on the previous trial. This flexibility was particularly evident in infants with more variable prior experience (the Probabilistic condition). The results provide some of the first data showing how infants learn in real time.

Statistical learning and language acquisition.

Human learners, including infants, are highly sensitive to structure in their environment. Statistical learning refers to the process of extracting this structure. A major question in language acquisition in the past few decades has been the extent to which infants use statistical learning mechanisms to acquire their native language. There have been many demonstrations showing infants' ability to extract structures in linguistic input, such as the transitional probability between adjacent elements. This paper reviews current research on how statistical learning contributes to language acquisition. Current research is extending the initial findings of infants' sensitivity to basic statistical information in many different directions, including investigating how infants represent regularities, learn about different levels of language, and integrate information across situations. These current directions emphasize studying statistical language learning in context: within language, within the infant learner, and within the environment as a whole. WIREs Cogn Sci 2010 1 906-914 This article is categorized under: Linguistics > Language Acquisition Psychology > Language.