Pathways to prevent e-cigarette use: Examining the effectiveness of the truth antivaping campaign.

OBJECTIVE: Mass media campaigns have been designed to counter a rise in e-cigarette use among young people. No studies to date have established pathways from campaign exposure to e-cigarette use behaviors. This study examines the mechanisms through which exposure to the truth® campaign may prevent the progression of e-cigarette use among youth and young adults. METHOD: Data included four waves of the truth longitudinal cohort, a probability-based, nationally representative survey: Wave 1: September 2020-March 2021; Wave 2: July-October 2021; Wave 3: January-May 2022; and Wave 4: October 2022-January 2023. The sample (N = 4,744) was aged 15-24 years and nicotine naive at Wave 1. Latent growth structural equation modeling techniques examined the pathway from cumulative frequency of ad exposure (CFE) to the e-cigarette use progression via campaign-targeted attitudes. RESULTS: The direct effect from CFE to e-cigarette use progression was not significant. The overall indirect pathway shows that CFE was significantly associated with lower progression of e-cigarette use (ß = -.01, p < .0001). CFE had a significant positive association with each campaign-targeted attitude, and each attitude was significantly associated with stronger perceived norms against e-cigarette use. Stronger perceived norms were significantly associated with a slower progression to e-cigarette use (ß = -.21, p < .0001). CONCLUSIONS: Awareness of the truth antivaping campaign follows a pathway of targeted attitudes and perceptions of acceptability, then to slowed progression toward initiation of e-cigarette use. Antivaping campaigns should focus on shifting perceptions of acceptability to reduce e-cigarette use among young people. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pathways to Quitting E-cigarettes Among Youth and Young Adults: Evidence From the truth® Campaign.

PURPOSE: This study examines the pathways through which e-cigarette users' awareness of the truth® campaign influences e-cigarette use frequency over time. DESIGN AND SETTING: Data included four waves (2020-2023) of the Truth Longitudinal Cohort, a probability-based, nationally representative survey. PARTICIPANTS: The analytic sample was 15-24-year-olds who reported current e-cigarette use at baseline (N = 718). Wave-by-wave retention rates were 64% to 69%. MEASURES: Respondents' cumulative awareness of truth® ads was calculated (Waves 1-2). Strength of agreement with campaign-targeted attitudes was measured on five-point scales (Wave 2). The outcome was change in the 4-level frequency of e-cigarette use (Waves 2-4). ANALYSIS: Latent growth structural equation modeling examined the pathway from cumulative ad awareness to the frequency of e-cigarette use via campaign-targeted attitudes. RESULTS: Model fit estimates identified a three-step pathway by which awareness of the campaign reduced e-cigarette use. Ad awareness was significantly associated with stronger campaign-targeted attitudes: perceived risk (ß = .20, P < .0001); anti-vape industry (ß = .13, P = .003); independence from addiction (ß = .13, P = .004); and affinity with groups that reject vaping (ß = .18, P < .0001). Each attitude was significantly associated with stronger perceived norms against e-cigarette use (respectively: ß = .25, P < .0001; ß = .15, P < .0001; ß = .12, P = .018; ß = .27, P < .0001). Perceived norms against e-cigarette use had a significant negative relationship with growth in e-cigarette use frequency over time (ß = -.23, P < .0001). CONCLUSION: Greater truth® anti-vaping ad awareness strengthens campaign-targeted attitudes among current users, increasing perceived norms against e-cigarette use and reducing use over time.

Patterns of Daily Cigarette and E-cigarette Use among United States Youth and Young Adults: Insights from the Truth Longitudinal Cohort between 2018 and 2019.

Purpose: Temporal patterns of daily tobacco product use among ever users from the Truth Longitudinal Cohort (TLC) between 2018 and 2019 were explored. Methods: The sample (N = 5274) includes individuals (15-36 years), residing in the United States, who had ever used any tobacco product at Wave 7 (February - May 2018) and provided tobacco use information at Wave 9 (September - December 2019). Results: There was a nonsignificant 1.1 percentage point increase in daily tobacco use (on at least 25 of the past 30 days), from 14.6% (95% CI: 12.8, 16.6) to 15.7% (95% CI: 13.8, 17.7). Tobacco product use remained stable over time, as 65.3% (95% CI: 56.4, 73.3) of daily cigarette smokers, 57.0% (95% CI: 43.6, 69.4) of daily e-cigarette vapers, and 8.5% (95% CI: 2.0, 29.3) of daily dual users stayed with their primary tobacco product. There was also some evidence of switching, as 7.5% (95% CI: 3.7, 14.8) of daily cigarette smokers became daily e-cigarette vapers and 2.3% (95% CI: 0.7, 6.8) of daily e-cigarette vapers became daily cigarette smokers. Discussion: Although most daily tobacco users were likely to continue using their primary product, some daily users transitioned to daily use of other products - suggesting that policies and public education focused on reducing overall nicotine use are essential for addressing the nicotine epidemic among young people.

E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018-2019).

This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.

Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study.

BACKGROUND: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. OBJECTIVE: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. METHODS: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google's Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. RESULTS: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=0.90, P<.001) and March 2020 to May 2022 (ρ=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ρ=0.90; P<.001; 18-20 years: ρ=0.87; P<.001; 21-24 years: ρ=0.88; P<.001), racial or ethnic minorities (ρ=0.86, P<.001), and respondents with lower socioeconomic status (ρ=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ=0.92, P<.001) and retail and recreation (ρ=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (ρ=0.68, P<.001) and parks (ρ=0.62, P<.001). A strong negative correlation was observed for places of residence (ρ=-0.78, P<.001), and a weak but significant positive correlation was found for workplaces (ρ=0.24, P<.001). CONCLUSIONS: The Transportation Security Administration's travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States.

Content analysis of tobacco imagery in popular music Videos, 2018-2021.

Exposure to tobacco imagery in movies and television has been identified as a key factor to youth smoking initiation (Davis, 2008; Bennett et al., 2020). This study aims to investigate the prevalence of tobacco imagery in popular music videos from 2018 to 2021. The weekly top 10 songs of 2018-2021 were identified using Billboard Charts categories (Hot 100, Hot R&B/Hip-Hop, Country, Rock & Alternative, Dance/Electronic, Pop Airplay). Content analyses of the top music videos using the Thumbs up Thumbs Down methodology were conducted to identify tobacco depictions on screen. The sample consisted of 1,008 music videos across four years; 196 of which contained tobacco imagery (19.4%). Between 2018 and 2021, the proportion of videos with tobacco imagery ranged between 12.8% and 23.0% of the total year sample. Tobacco incidences almost doubled from 280 occurrences in 2018 to 522 occurrences in 2020, but decreased by over half to 290 occurrences in 2021. Tobacco incidences varied by year and genre, with Hot 100 being the top offending genre in 2018 with 40.0% of videos containing tobacco imagery while Hot R&B/Hip-Hop was the top offending genre from 2019 to 2021 (52.7%, 52.5%, and 23.9% respectively). Cigarettes were most pervasive in 2019 (70.1% of total tobacco incidences), 2020 (45.6%), and 2021 (64.1%) music videos. Pipes were the most pervasive product in 2018 music videos (39.6%). Given the reach and frequency of exposure to music videos among young people, reducing tobacco imagery in popular music videos may prevent tobacco use among young people.

Youth E-Cigarette Initiation After the Food and Drug Administration's Missed Deadline.

INTRODUCTION: The U.S. Food and Drug Administration was ordered to evaluate electronic nicotine delivery system (ENDS) products by September 9, 2021, but missed the court-ordered deadline. This study provides an estimate of electronic cigarette (E-cigarette) use initiation among youth and young adults after the U.S. Food and Drug Administration's missed deadline. METHODS: Data were obtained from the Truth Longitudinal Cohort, a probability-based longitudinal sample of youth and young adults aged between 15 and 24 years (N=1,393). Respondents were surveyed at baseline (July-October 2021) and at follow-up (January-June 2022). Individuals who had not previously used any E-cigarette products were included in analyses conducted in 2022. RESULTS: Results indicate that 6.9% of youth and young adults had initiated E-cigarette use, suggesting that about 900,000 youth aged 15-17 years and 320,000 young adults aged 18-20 years initiated E-cigarette use after the U.S. Food and Drug Administration's missed court-ordered deadline. CONCLUSIONS: Over a million youth and young adults initiated E-cigarette use after the U.S. Food and Drug Administration's missed court-ordered deadline. The U.S. Food and Drug Administration needs to continue evaluating premarket tobacco product applications, enforce decisions on premarket tobacco product applications, and remove E-cigarettes that are deemed harmful to public health to effectively address the E-cigarette epidemic among young people.

E-cigarette Device Type, Source, and Use Behaviors of Youth and Young Adults: Findings from the Truth Longitudinal Cohort (2020-2021).

Background: E-cigarette device types vary in the amount of nicotine delivered to users. Given that youth and young adults are using pod-based and disposable e-cigarettes with high nicotine concentrations, it is important to determine how e-cigarette use behaviors associated with nicotine dependence may differ across e-cigarette device type. Methods: Baseline information was collected from September 2020 to March 2021 and follow-up information was collected from July to October 2021 from the Truth Longitudinal Cohort. The final analytic sample included respondents (aged 15-24) who reported current use of e-cigarettes at either baseline or follow-up and provided information on the 4-item E-cigarette Dependence Scale (EDS). Differences in endorsement of items from the EDS by e-cigarette device type (pod-based, disposable, or tank) were assessed using chi-square tests. Results: Participants (N = 308) were evenly split on age (15-20, 21+) and gender. Most 15-20-year-olds used disposable e-cigarettes, while those 21+ years primarily used tank devices. Although EDS score did not differ by e-cigarette device type, positive endorsement of two items from the EDS significantly differed by e-cigarette device type. More tank users endorsed reaching for a device without thinking about it (tank: 92.6%; pod-based: 79.0%; disposables: 79.9%, p = 0.04) and vaping more before going into a situation where vaping is not allowed (tank: 92.9%; pod-based: 71.0%; disposables: 73.0%, p < 0.01). Conclusions: Findings have the potential to inform policy implementation by providing evidence for specific targets for regulatory action that can help to reduce the burdens of e-cigarette use among youth and young adults, as results suggest that tank device users are more likely to endorse use behaviors associated with nicotine dependence.

A resurgence of e-cigarette use among adolescents and young adults late in the COVID-19 pandemic.

BACKGROUND: Early in the COVID-19 pandemic, e-cigarette use significantly declined among young people due, in part, to losing access through social sources. As the pandemic progressed, adolescents and young adults gained opportunities to resume contact with peers. This study sought to determine whether e-cigarette use has returned to pre-pandemic levels among adolescents and young adults. METHODS: Data were drawn from a cross-sectional weekly survey of adolescents (aged 15-17) and young adults (aged 18-24) (N = 37,331). Logistic regression analyses measured odds of past 30-day e-cigarette use among respondents surveyed (a) late in the pandemic (April 2021-April 2022) compared to early in the pandemic (March-July 2020) and (b) late in the pandemic (August-December 2021) compared to prior to the pandemic (August-December 2019). RESULTS: The odds of current e-cigarette use were significantly higher later in the COVID-19 pandemic (April 2021-April 2022), compared to its initial months (March-July 2020) (OR:1.27, 95% CI: 1.17-1.38; p = 0.001). There was no significant difference in the odds of e-cigarette use for youth and younger adults late in the pandemic (August-December 2021) compared to the same time period prior to the pandemic (August-December 2019), but odds were greater for young adults aged 21 years or older (OR:1.16; 95% CI: 1.01-1.32; p = 0.030). CONCLUSIONS: E-cigarette use has returned to pre-pandemic levels among adolescents and young adults. Young adults over age 21 are more likely to use e-cigarettes than young adults of the same age surveyed prior to the pandemic. Findings have implications for targeted e-cigarette prevention and cessation efforts.

Perceived Sensory Characteristics of Blended and Ambiguous "Concept" Flavors Among Adolescent and Young Adult E-cigarette Users.

INTRODUCTION: Flavors with names describing blended tastes/sensations or with ambiguous terminology ("concept flavors") are available on the e-cigarette market. AIMS AND METHODS: This study investigates adolescent and young adult use and sensory perceptions of blended and concept flavors. Current e-cigarette users aged 15-24 years (N = 2281) completed an online convenience sample survey (October 20-November 23, 2020) and rated the sensory attributes (fruity, cooling, sweet, and minty) of their current flavor(s) using nine-point scales. T-tests compared mean sensory perception scores within and between flavors. To compare concept flavors to blends, reference categories used the average of blends with relevant descriptors: fruit (Banana Ice, Iced Mango, Melon Ice, Cool Cucumber); cooling (Banana Ice, Iced Mango, Melon Ice, Blue B Ice, Cool Cucumber, Lush Ice, and Menthol Purple); sweet (Vivid Vanilla) and mint (Mint-sation). RESULTS: Most respondents had used at least one product with blended descriptors (74.8%) or concept flavor (57.9%) in the past 30 days. All flavors had high perceived strength for at least two sensory attributes. Mint taste was not perceived to be a strong sensory characteristic for all but two flavors (Mint-sation and Winter) in the study. The most commonly used flavors used blended descriptors (Iced Mango was used by 30.2% of the sample; Banana Ice: 26.2%; Lush Ice: 23.8%; Melon Ice: 22.9%). Some concept flavors did not significantly differ from flavor blend reference categories for strength of: fruit taste (Bahama Mama and Tropic); cooling sensation (Marigold, Island Breeze, Winter); sweet taste (Bahama Mama, Honeymoon, Island Breeze, Island Cream, Meteor Milk, OMG, Royal Dagger and Tropic); and mint taste (Winter). CONCLUSIONS: Blended and concept flavors are used by most young e-cigarette users, who describe these products as fruity, sweet, and cooling. A variety of flavored products with high youth appeal are available in the U.S. market. IMPLICATIONS: This study of adolescent and young adult e-cigarette users finds evidence of the popularity of e-cigarette flavors combining a cooling sensation with fruity and sweet flavorings. Some products with this flavor profile do not use characterizing descriptors. Findings inform public health interventions intended to reduce e-cigarette use in young people.

Underage Youth Continue to Obtain E-Cigarettes from Retail Sources in 2022: Evidence from the Truth Continuous Tracking Survey.

(1) Background: This study aims to describe the primary sources of e-cigarettes among young people and to explore how these sources may differ by individual-level characteristics. (2) Methods: Data were obtained from a cross-sectional, continuous tracking survey of participants. The analytic sample includes current e-cigarette users (aged 15-20 years) surveyed from January to August 2022 (N = 1296). Respondents provided information on e-cigarette source of acquisition, device type, and flavors used, as well as sociodemographic and residential characteristics. Chi-square tests were used to determine differences in source of acquisition by age, gender, race/ethnicity, United States (US) census region, urban-rural classification, flavors used, and device type. (3) Results: Although most current e-cigarette users obtained their devices through a social source (56.9%), a considerable proportion obtained e-cigarettes from a retail source (43.1%). The primary retail sources of e-cigarette acquisition were vape shops (22.0%) and gas station/convenience stores (15.9%). Source of e-cigarette acquisition differed by age, gender, US census region, flavors used, and device type, such that a lower proportion of those who were younger, female, residing in the West, and used vape pens had reported obtaining e-cigarettes via retail sources. (4) Conclusions: Results indicate that a significant proportion of youth report obtaining e-cigarettes from retail sources, despite the federal, state, and local policies that prohibit the sale of any tobacco products to those under the age of 21. Comprehensive retail regulations to help restrict tobacco product access are needed to reduce e-cigarette use among young people.

Transitions in Frequent to Daily Tobacco and Nicotine Use among Youth and Young Adults.

Objective: To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigarillos, and cigars (LCCs) over time. Methods: Data were obtained from the Truth Longitudinal Cohort (TLC), a nationally representative longitudinal cohort of youth and young adults. Latent class analysis was conducted to classify participants (n = 5274) into subgroups based upon frequency of use of cigarettes, e-cigarettes, and little cigars, cigarillos, and cigars (LCCs) in the past 30 days. Latent transition analysis was used to estimate the probability of use pattern transitions across 23 months (February 2018 to December 2019), adjusted for the effects of gender, race/ethnicity, financial situation, sensation seeking, parent education, and household smoking. Findings: Findings reveal four groups of tobacco product users: (1) frequent to daily cigarette users (9%), (2) frequent to daily cigarette and LCC users (3%), (3) frequent to daily e-cigarette users (10%), and (4) former or noncurrent tobacco users (78%). Although most respondents (69-94%) retained their initial user patterns during the observation period, results also indicate shifts between user groups. Notably, 14% of frequent to daily cigarette and LCC users transitioned to frequent to daily cigarette use, while 6% of frequent to daily cigarette and LCC users, 9% of frequent to daily cigarette users, and 4% of former or noncurrent tobacco users transitioned to frequent to daily e-cigarette use. Conclusion: Although most frequent to daily tobacco users stay with their primary product, there are transitions between frequent to daily cigarette, e-cigarette, and LCC use. Transition patterns may influence risk for nicotine addiction among youth and young adults. Thus, policies focused on preventing and reducing all tobacco use are needed to curb the risk of nicotine addiction among youth and young adults.

Developing the Message Assessment Scale for Tobacco Prevention Campaigns: Cross-sectional Validation Study.

BACKGROUND: Mass media campaigns are effective for influencing a broad range of health behaviors. Prior to launching a campaign, developers often conduct ad testing to help identify the strengths and weaknesses of the message executions among the campaign's target audience. This process allows for changes to be made to ads, making them more relevant to or better received by the target audience before they are finalized. To assess the effectiveness of an ad's message and execution, campaign ads are often rated using a single item or multiple items on a scale, and scores are calculated. Endorsement of a 6-item perceived message effectiveness (PME) scale, defined as the practice of using a target audience's evaluative ratings to inform message selection, is one approach commonly used to select messages for antitobacco campaigns; however, the 6-item PME scale often does not produce enough specificity to make important decisions on ad optimization. In addition, the PME scale is typically used with adult populations for smoking cessation messages. OBJECTIVE: This study includes the development of the Message Assessment Scale, a new tobacco prevention message testing scale for youth and young adults. METHODS: Data were derived from numerous cross-sectional surveys designed to test the relevance and potential efficacy of antitobacco truth campaign ads. Participants aged 15-24 years (N=6108) responded to a set of 12 core attitudinal items, including relevance (both personal and cultural) as well as comprehension of the ad's main message. RESULTS: Analyses were completed in two phases. In phase I, mean scores were calculated for each of the 12 attitudinal items by ad type, with higher scores indicating more endorsement of the item. Next, all items were submitted to exploratory factor analysis. A four-factor model fit was revealed and verified with confirmatory factor analysis, resulting in the following constructs: personally relevant, culturally relevant, the strength of messaging, and negative attributes. In phase II, ads were categorized by performance (high/medium/low), and constructs identified in phase I were correlated with key campaign outcomes (ie, main fact agreement and likelihood to vape). Phase II confirmed that the four constructs identified in phase I were all significantly correlated with main fact agreement and vape intentions. CONCLUSIONS: Findings from this study advance the field by establishing an expanded set of validated items to comprehensively assess the potential effectiveness of advertising executions. This set of items expands the portfolio of ad testing measures for ads focused on tobacco use prevention. Findings can inform how best to optimize ad executions and message delivery for health behavior campaigns, particularly those focused on tobacco use prevention among youth and young adult populations.

Influence of Flavors and Nicotine Concentration on Nicotine Dependence in Adolescent and Young Adult E-Cigarette Users.

Objective: The objective of this study is to examine the relationships between e-cigarette flavors, nicotine concentration, and their interaction on measures of nicotine dependence.Methods: Survey data are drawn from a cross-sectional convenience sample of past 30-day e-cigarette users aged 15 to 24 years (N = 2037) collected between October 2020 and November 2020. Participants were asked to provide information about the e-cigarette products they used most regularly. Only those with available information on flavors (fruit, mint, menthol/ice, and tobacco), nicotine concentration (0-2.9%, 3-4.9%, and 5% or greater), and time to first vape after waking (within 30 minutes, greater than 30 minutes) were included in analyses (N = 1430). Generalized linear regression models were used with log link and binary distribution to assess the relationship between flavors, nicotine concentration, and nicotine dependence. Effect modification by nicotine concentration was assessed using an interaction term for flavors by nicotine concentration. Models were adjusted for age, race/ethnicity, gender, and financial situation.Findings: Fruit, mint, and menthol flavor user groups had a very similar dose-response relationship between nicotine concentration and prevalence of vaping within 30 minutes. These groups showed that the prevalence of vaping within 30 minutes gradually increased as nicotine concentration increased. Meanwhile, tobacco flavor user groups demonstrated a decrease in prevalence of vaping within 30 minutes, as nicotine concentration increased.Conclusion: Results highlight the need for understanding how e-cigarette product characteristics like flavors and nicotine concentration can facilitate nicotine dependence to e-cigarettes. Findings suggest that comprehensive e-cigarette product regulation of all flavors and reducing nicotine concentration will help to reduce the risk for nicotine dependence among young people.

Evidence of the impact of a national anti-tobacco prevention campaign across demographic subgroups.

Mass media campaigns are an effective population-level intervention for preventing tobacco use. However, little evidence exists for whether these campaigns similarly influence demographic subgroups. This study examined the effects of the truth® campaign to reduce tobacco use among demographic subgroups. We used data from a national, continuous, cross-sectional tracking survey of 15-24-year-olds (n = 32 331). We used a measure of weekly aggregated campaign exposure to assess whether cigarette smoking intentions and current cigarette use varied by race/ethnicity, financial situation and population density subgroups, controlling for factors known to be associated with tobacco use. Examining estimates across subgroup categories in light of the overall model estimates revealed that the effects of week-level campaign exposure on cigarette smoking intentions and current cigarette use were similar across subgroups. Wald tests of equality across estimates in each subgroup suggested that the estimates did not differ from one another in any given instance. The truth campaign does not differ significantly in its capacity to prompt declines in tobacco use across a broad spectrum of US youth and young adults. Mass media tobacco prevention campaigns can be an effective and critical component of a comprehensive tobacco control program, particularly with respect to reducing tobacco-related disparities among demographic subgroups.

Youth and young adult risk perceptions and behaviours in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA.

OBJECTIVE: To determine whether awareness of emerging vaping-attributable health conditions influences vaping-related risk perceptions and behaviours among young people. DESIGN: Respondents aged 15-24 years (n=3536) were drawn from a repeated cross-sectional online panel survey (222 participants/week) during an e-cigarette/vaping-associated lung injury (EVALI) outbreak in the USA (September 2019-January 2020). Logistic regression models tested for associations between EVALI awareness and perceived lung injury risk and product harm, stratified by e-cigarette/vape use and controlling for awareness of other e-cigarette/vaping news stories, demographic characteristics and outbreak week. Other models measured the association between perceived risk of lung injury and intentions to use (non-users) or intentions to quit (current users) e-cigarettes/vape products. Changes in national retail e-cigarette sales data were examined during national EVALI outbreak reporting. RESULTS: EVALI awareness was associated with: perceived risk of lung injury (current users OR 1.59, p=0.004; non-users OR 2.11, p<0.001); belief that e-cigarettes/vapes contain dangerous chemicals (current users OR 1.47, p=0.017; non-users OR 1.88, p<0.001) and belief that e-cigarettes/vapes are harmful (current users OR 1.66, p=0.002; non-users OR 1.67, p<0.001). Perceived risk of lung injury from e-cigarette/vape use was associated with intentions to own e-cigarette/vape products (ever-users OR 0.25, p<0.001; never-users OR 0.61, p=0.004) and intentions to quit among current users (OR 2.02, p=0.002). Declines in e-cigarette sales were observed following news of the EVALI outbreak. CONCLUSIONS: News of vaping-attributable health conditions may prevent e-cigarette/vape use and encourage cessation among young people. Tobacco control campaigns should address uncertain health effects of e-cigarettes or vape products and align with risk communication by public health agencies during outbreaks.

A longitudinal analysis of e-cigarette use and cigar, little cigar or cigarillo initiation among youth and youth adults: 2017-2019.

PURPOSE: To examine whether youth and young adult e-cigarette use is associated with initiation of cigars, little cigars, or cigarillos (CLCCs) and current use of flavored CLCCs. BASIC PROCEDURES: The sample is drawn from the Truth Longitudinal Cohort, a probability-based longitudinal cohort of youth and young adults recruited at ages 15-21 and surveyed every six months. The sample for this study was CLCC-naïve defined as those who had never used CLCCs as of 2017 (N = 5586). The outcomes were the odds of (1) initiating any CLCC use and (2) reporting current (past 30-day) use of flavored CLCCs from 2018 to late 2019. The main predictor was use of e-cigarettes by 2018. RESULTS: The odds of initiating a CLCC was greater for those who had used ever used JUUL (OR: 3.30, p < 0.001) or were current users of another type of e-cigarette by 2018 (OR: 3.57, p < 0.001). Odds of CLCC initiation was also greater for those who had ever used combustible cigarettes (OR: 1.62, p < 0.05), were current smokers (OR: 3.12, p < 0.001) or had used marijuana (OR: 1.92, p < 0.001) by 2018. E-cigarette use that occurred by 2018 was associated with greater odds of current use of flavored CLCCs compared to non-flavored CLCCs (ever users of JUUL: OR: 2.57, p < 0.01; current users of some other e-cigarette: OR: 3.06, p < 0.05). CONCLUSION AND RELEVANCE: This study raises new concerns about the effects of e-cigarette use on subsequent combustible tobacco use. Restrictions on CLCCs should be considered in conjunction with current policies designed to reduce the youth vaping epidemic.

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.

E-Cigarette Use Among Youths and Young Adults During the COVID-19 Pandemic: United States, 2020.

Objectives. To determine whether the COVID-19 pandemic affected e-cigarette use among young people in the United States.Methods. Data came from a weekly cross-sectional online survey of youths and young adults (aged 15-24 years). Logistic regression analyses measured odds of past-30-day e-cigarette use (n = 5752) following widespread stay-at-home directives (March 14-June 29, 2020), compared with the pre‒COVID-19 period (January 1-March 13, 2020). Logistic regression among a subsample of current e-cigarette users (n = 779) examined factors associated with reduced use following stay-at-home orders.Results. Odds of current e-cigarette use were significantly lower during the COVID-19 pandemic compared with the pre‒COVID-19 period among youths aged 15 to 17 years (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.96) and young adults aged 18 to 20 years (OR = 0.65; 95% CI = 0.52, 0.81). E-cigarette users with reduced access to retail environments had higher odds of reporting reduced e-cigarette use (OR = 1.51; 95% CI = 1.07, 2.14).Conclusions. COVID-19 stay-at-home directives present barriers to e-cigarette access and are associated with a decline in e-cigarette use among young people.Public Health Implications. Findings support the urgent implementation of interventions that reduce underage access to e-cigarettes to accelerate a downward trajectory of youth and young adult e-cigarette use.