Are Black and Latino adolescents being asked if they use electronic cigarettes and advised not to use them? Results from a community-based survey.

Objective: This study aimed to explore whether African American/Black and Hispanic/Latino adolescents are being asked about electronic cigarette (e-cigarette) use (vaping) and advised not to use them. Methods: In 2021, adolescents (N = 362) with no vaping history, self-identified as African American/Black and/or Hispanic/Latino, and able to read and speak English and/or Spanish were recruited through partner schools and community-based organizations. Participants completed a survey reporting sociodemographic characteristics (e.g., race/ethnicity, gender, and language of preference) and they were asked about e-cigarette use and/or were advised not to use them by a health professional. Results: In total, 12% of African American/Black and 5% of Hispanic/Latino participants reported not seeing a health professional in the year prior to enrollment. Of the participants who reported visiting a health professional, 50.8% reported being asked and advised about vaping. Over one-quarter (28.4%) of participants were neither asked nor advised regarding vaping. Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to be asked about e-cigarette use (45.2 vs. 63.9%, p = 0.009) and advised not to use them (40.3 vs. 66.9%, p < 0.001). Moreover, compared to African American/Black participants, Hispanic/Latino participants were significantly less likely to be advised not to use e-cigarettes (52.9 vs. 68.6%, p = 0.018). Furthermore, compared to male participants, female participants were significantly less likely to be advised not to use e-cigarettes (51.3 vs. 68.2%, p = 0.003). Conclusion: Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to self-report being asked about e-cigarette use and advised not to use them. Moreover, Hispanic/Latino and female adolescents were significantly less likely to self-report being advised not to use e-cigarettes compared to their Black/African American and male counterparts. Future research is needed to improve health professional attention toward asking about and advising against vaping among adolescents.

Asian American adolescent e-cigarette use and associated protective factors: Heterogeneity in a statewide sample.

OBJECTIVES: This study characterized variation in e-cigarette use patterns and related protective factors by ethnicity among Asian American adolescents. METHODS: Multivariable logistic regressions modelled associations between ethnic group, 6 protective factors (college aspirations, internal developmental assets, positive teacher engagement, family caring, and peer and parent anti-smoking norms), and past 30-day e-cigarette use, adjusting for covariates among 10,482 8th, 9th, and 11th grade Asian American respondents to the 2019 Minnesota Student Survey. Interaction terms (protective factor × ethnic group) were used in 6 subsequent regression models to examine whether the association between each protective factor and e-cigarette use differed as a function of ethnic group. RESULTS: Respondents included 9.0% Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multi-ethnic, and 21.6% multi-racial adolescents. E-cigarettes were the predominant form of tobacco use. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indians reported the lowest (4.7% and 5.0%). Strong peer anti-smoking norms, higher internal developmental assets scores, and positive teacher engagement were associated with lower odds of e-cigarette use across groups, with significant interactions for internal developmental assets by ethnicity. CONCLUSIONS: E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota, with notable heterogeneity by ethnicity. While most established protective factors appeared to function similarly for Asian adolescents, others differed, underscoring the importance of disaggregating data by ethnicity to inform the tailoring of prevention and control strategies for these ethnic groups.

Age of e-cigarette initiation in USA young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study (2013-2017).

INTRODUCTION: There is a lack of research prospectively estimating the age of e-cigarette initiation in U.S. young adults. METHODS: Secondary analysis of PATH young adults across 2013-2017 (waves 1-4) were conducted. We prospectively estimated age of initiation of: ever, past 30-day, and fairly regular e-cigarette use using weighted interval-censoring survival analyses. Interval-censoring Cox proportional hazard models adjusting for sex, race/ethnicity, and previous use of six other tobacco products (cigarettes, traditional cigars, filtered cigars, cigarillos, hookah, and smokeless tobacco) were fitted for each of the three e-cigarette initiation outcomes. RESULTS: Among never e-cigarette users, by age 21, 16.8% reported ever use, 7.2% reported past 30-day use, and 2.3% reported fairly regular e-cigarette use. Males had increased risk of initiating ever, past 30-day, and fairly regular e-cigarette use at earlier ages compared to females. Hispanic young adults had increased risk of initiating ever and past 30-day e-cigarette use at earlier ages compared to Non-Hispanic White young adults. Previous use of other tobacco products before e-cigarette initiation increased the risk of an earlier age of e-cigarette initiation. CONCLUSION: Prevention and education campaigns should focus on young adults in order to alleviate the public health burden of initiating e-cigarette use at earlier ages.

How Is Use of Electronic Cigarettes Related to Conventional Cigarette Use? A Qualitative Study among Korean American Young Adults.

Given the growing popularity of e-cigarettes in the United States, there is a need to understand the relationship between conventional and electronic cigarette use among Korean American young adults. Thus, this study aimed to explore Korean American young adults' experience of electronic cigarettes and its association with use of conventional cigarettes. This study employed an exploratory qualitative design. Individual interviews were conducted with 15 Korean American young adults aged between 18 and 25 years who reported having smoked at least one conventional cigarette per day for the past 6 months. Interview data were subjected to thematic analysis in order to gain an in-depth understanding of the interconnection between e-cigarette and conventional cigarette use. Data analysis revealed three themes involving reasons for buying, using, and stopping use of e-cigarettes, each of which had several sub-themes. Study results suggest that experience of e-cigarettes was related to conventional cigarette use. Thus, the experience of e-cigarettes as well as conventional cigarettes should be considered in designing smoking cessation interventions for Korean American young adults.

Electronic cigarette use among university students aged 18-24 years in New Zealand: results of a 2018 national cross-sectional survey.

OBJECTIVES: To examine electronic cigarette use, reasons for use and perceptions of harm among university students. DESIGN: Cross-sectional study. SETTING: University students across New Zealand. METHODS: We analysed data from a 2018 cross-sectional survey of university students, weighted to account for undersampling and oversampling by gender and university size. χ2 tests were used to compare e-cigarette use, reasons for use and perceptions of harm by age, gender, ethnicity and cigarette smoking. PARTICIPANTS: The sample comprised 1476 students: 62.3% aged 18-20 years, 37.7% aged 21-24 years; 38.6% male, 61.4% female; 7.9% Maori and 92.1% non-Maori. RESULTS: 40.5% of respondents (95% CI 37.9 to 43.1) reported ever, 6.1% (4.9-7.4) current and 1.7% (1.1-2.5) daily use. Regardless of frequency, 11.5% of vapers had vaped daily for ≥1 month, 70.2% of whom used nicotine-containing devices; 80.8% reported not vaping in indoor and 73.8% in outdoor smoke-free spaces. Among ever vapers, curiosity (67.4%), enjoyment (14.4%) and quitting (2.4%) were common reasons for vaping. 76.1% (73.4-78.7) of respondents believed e-cigarettes were less harmful than cigarettes.More males than females reported vaping (ever, current, daily and daily for ≥1 month), nicotine use and belief that e-cigarettes were less harmful than cigarettes. More participants aged 18-20 years reported not vaping in outdoor smoke-free spaces, vaping out of curiosity and belief that e-cigarettes were less harmful than cigarettes, while more participants aged 21-24 years vaped daily for ≥1 month and for enjoyment. More Maori than non-Maori ever vaped. More cigarette smokers than non-smokers vaped (ever, current, daily and daily for ≥1 month), used nicotine and vaped to quit, while more non-smokers did not vape in smoke-free spaces and vaped out of curiosity. CONCLUSIONS: Our results suggest high prevalence of e-cigarette ever and current use, particularly among males and smokers. Many vaped out of curiosity and perceived e-cigarettes as less harmful than cigarettes.

Electronic cigarette use and psychological distress in the Native Hawaiian and Pacific Islander adults compared with other racial/ethnic groups: Data from the National Health Interview Survey, 2014.

Document the prevalence of electronic cigarette (E-cigarette) use among the native Hawaiian and other Pacific Islander (NHPI) adults compared with other racial/ethnic groups, and examine associations between psychological distress and E-cigarette use. 2014 National Health Interview Survey (NHIS) and 2014 NHPI-NHIS were combined for comparisons. Data were analyzed using descriptive statistics, Rao-Scott χ2 test, and multivariable logistic regression. E-cigarette use among NHPI (5.6%) was significantly higher than among Blacks (2.1%), Hispanics (2.2%), and Asians (1.7%; p < .001). NHPI with Kessler 6 (K6) score of 11-24 had greater odds of using E-cigarettes (odds ratio [OR]: 3.90; 95% confidence intervals [CI]: 1.81-8.42) as compared to those with a K6 score of 0. Associations between having a K6 score of 11-24 and using E-cigarettes were also found for Whites (OR: 3.49; CI: 2.44-4.99), Asians (OR: 5.29; CI: 1.29-21.70), and Hispanics (OR: 6.14; CI: 2.72-13.83). E-cigarette use was higher among NHPI relative to other racial/ethnic groups. NHPI with K6 score of 11-24 had greater odds of using E-cigarettes as compared to those with a K6 score of 0. Policies and strategies to reduce E-cigarette use among NHPI should give careful consideration to the associations between E-cigarette use and psychological distress in the NHPI population.

Prevalence and reasons for Juul use among college students.

Objective: Examine Juul use patterns, sociodemographic and personal factors associated with Juul use, and reasons for Juul initiation and current use, among college students. Participants: Convenience sample of 371 undergraduates at a large university in the southeast; recruited April 2018. Methods: Cross-sectional design using an online survey. Logistic regression identified the personal risk factors for current use. Results: Over 80% of participants recognized Juul; 36% reported ever use and 21% past 30-day use. Significant risk factors for current Juul use were: male, White/non-Hispanic, lower undergraduate, and current cigarette smoker. Current Juul users chose ease of use and lack of a bad smell as reasons for use. Ever Juul users most commonly endorsed curiosity and use by friends as reasons for trying Juul. Conclusions: Given the propensity for nicotine addiction among youth and young adults, rates of Juul use are alarming and warrant immediate intervention.

Use of E-Cigarettes for Nicotine, Marijuana, and Just Flavoring Among U.S. Youth.

INTRODUCTION: E-cigarette use is gaining popularity among youth, but knowledge on patterns of youth vaping different substances is limited. This study examines risk factors associated with past-30-day self-reported vaping of nicotine, marijuana, and just flavoring among youth and the patterns (single, dual, and poly) of substances youth reported in their e-cigarettes. METHODS: The 2017 Monitoring the Future survey was analyzed. Weighted estimates of substances that youth vaped were calculated, and multivariable logistic regressions were performed to examine risk factors associated with youth vaping these substances. Analyses were conducted in 2019. RESULTS: Overall (n=14,560), 8.0% of participants reported currently vaping just flavoring, followed by 7.4% vaping nicotine and 3.6% vaping marijuana. Youth who were in 12th and 10th grade (versus 8th grade), male (versus female), current smokers (versus noncurrent smokers), and current marijuana users (versus noncurrent users) had increased risk of vaping nicotine, marijuana, and just flavoring. Black non-Hispanics were less likely than white non-Hispanics to report currently vaping. Among students who reported e-cigarette use in the last 30 days (n=1,685), only 24.9% reported vaping just flavoring only, and a majority (75.1%) reported vaping nicotine, marijuana, or multiple substances. Higher (versus lower) grade or increasing cigarette smoking intensity was associated with a higher proportion of students reporting vaping nicotine only and a lower proportion of students reporting vaping just flavoring only. CONCLUSIONS: Youth e-cigarette use reveals a complex pattern, and youth reported vaping substances potentially addictive beyond just flavoring. Strategies and interventions to reduce youth e-cigarette use are needed.

Vaping patterns, nicotine dependence and reasons for vaping among American Indian dual users of cigarettes and electronic cigarettes.

BACKGROUND: The American Cancer Society discourages the dual use of electronic cigarettes (ECs) and cigarettes because such use has not resulted in reduced exposures to the harmful effects of smoking. American Indian (AI) people have the highest prevalence of smoking and of EC use in the United States, but very little is known about dual EC and cigarette use in AI communities. METHODS: In 2016, 375 adult AI in Oklahoma who smoked cigarettes completed a survey about EC use (vaping). We describe vaping patterns, nicotine dependence, and reasons for EC use among the subset of 44 (12%) current dual EC users. To differentiate habitual EC users from occasional or merely curious users, we defined dual use as using ECs on some days or every day in the past 30 days. RESULTS: About one-third of dual users vaped ten or more times daily. About two-thirds used a tank product. Eleven percent used ECs without nicotine and another 9% were unsure of the nicotine content. A minority (40%) enjoyed vaping more than smoking, and most (76%) would smoke first on days they did both. Thirty-one percent vaped within 5 min of waking and another 24% within 30 min. Although the two-item heaviness of use index did not differ significantly between smoking and vaping, the ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping (11.02 vs. 6.42, respectively; p < .0001). The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them. CONCLUSIONS: Nearly 20% of dual users used ECs either without nicotine or without knowing if the product contained nicotine. The PSDI indicated greater dependence on smoking than vaping. Reasons for vaping were nearly equal between smoking reduction and enjoying flavors. Understanding patterns of dual use will inform future efforts to address nicotine dependence for AI communities with high prevalence of smoking.

Personal Motivations of Asian Americans Who Use ENDS: A Qualitative Study.

Objectives: The purpose of this study is to explore the motivations that encourage Asian Americans to use ENDS. In addition, it seeks to evaluate the underlying implications of Asian cultural beliefs and values that influence the use of ENDS. Methods: We conducted 12 semi-structured in-depth interviews among Asian Americans. Data were analyzed using thematic analysis. Results: Participants were influenced by Asian cultural values of filial piety and saving face which allowed them to either de-stigmatize or conceal the use of ENDS among their family members and peers. They also reported preferences for e-juice flavors reflective of food and products prominent in the Asian culture. Moreover, respondents also believed that ENDS use is less harmful than combustible cigarettes and reported experiencing perceived health benefits. Conclusion: Asian Americans who use ENDS are encouraged by the perception of their family members and value a sense of comfortability and familiarity when choosing their e-juice flavors. These results can help inform public health educators and researchers create culturally-specific health campaigns and interventions targeting the Asian-American population.

Prevalence of e-cigarette use from a nationally representative sample in New Zealand.

OBJECTIVE: To explore the prevalence of e-cigarette use in New Zealand in a nationally representative sample aged 15 years and over. METHODS: The Health and Lifestyles Survey (HLS) is a biennial face-to-face in-house survey of New Zealand adults aged 15 years or over. The HLS was completed by 3854 participants in 2016. RESULTS: 17% of adults have tried e-cigarettes, while only 2% reported current use. The prevalence of ever use of e-cigarettes was greater in young and middle-aged adults, compared with older adults, Maori compared with NZ European, and current and former smokers, compared to never smokers. Current smokers and recent quitters displayed the highest levels of e-cigarette use, with never smokers reporting low ever use (2.8%) and no regular use. Following adjusted analyses only current smokers and recent quitters were more likely to report current or daily e-cigarette use. CONCLUSION: Although 17% of adults report having tried e-cigarettes, very few report current use. It is possible that difficulty of use, compounded by lack of support, is preventing conversion to regular use or successful use as a quitting aid. Public health initiatives should inform individuals how to correctly use e-cigarettes optimally for smoking cessation, ideally targeting this messaging toward younger and middle-aged adults, Maori, current smokers, and recent quitters.

Ethnic Differences in Patterns of Cigarette and E-Cigarette Use Over Time Among Adolescents.

PURPOSE: Little is known about whether adolescent cigarette and e-cigarette use patterns over time differ by ethnicity. METHODS: Data were pooled from three prospective cohort studies of adolescents in California and Connecticut (baseline: 2013-2014; 12-month follow-up: 2014-2015; N = 6,258). Adjusted polytomous regression models evaluated the association of baseline exclusive ever e-cigarette use, exclusive ever cigarette use, ever use of both e-cigarettes and cigarettes (dual use) with past 30-day use at follow-up (exclusively e-cigarettes, exclusively cigarettes, dual use; no use at baseline/follow-up were the referent groups). Interaction analyses evaluated differences by race/ethnicity (Hispanic white [HW], non-Hispanic white [NHW], Other). RESULTS: A significant global interaction was observed for the association of baseline with follow-up tobacco use by ethnicity (p = .009). Among NHW participants, ever e-cigarette or cigarette users at baseline (vs. never users) had significantly higher odds of every past 30-day use tobacco use pattern at follow-up. Among HW participants, compared with never users, exclusive e-cigarette users at baseline had increased odds of continued e-cigarette use (ORexclusive e-cigarettes = 5.22; 95% confidence interval [CI]: 3.50, 7.79; ORdual use = 3.64; 95% CI: 1.62, 8.18) but not of transition to exclusive cigarette use at follow-up (ORexclusive cigarettes = 1.27; 95% CI: .47, 3.46), and HW exclusive cigarette users at baseline had greater odds of continued cigarette use (ORexclusive e-cigarettes = 12.3; 95% CI: 5.87, 25.8; ORdual use = 3.82; 95% CI: 1.06, 13.7) but not of transition to exclusive e-cigarette use at follow-up (ORexclusive cigarettes = 1.61; 95% CI: .62, 4.18). CONCLUSIONS: Findings that NHW youth report more transitional use patterns and HW youth report more stable use patterns suggest a potential for differential impacts of e-cigarettes, by ethnicity, in increasing subsequent transition to or cessation from cigarette smoking.

Demographic, Behavioral, and Social Characteristics Associated With Smoking and Vaping Among Men Who Have Sex With Men in San Francisco.

Tobacco use is the leading lifestyle-related cause of death in the United States. We analyzed correlates of smoking and vaping tobacco in the National HIV Behavioral Surveillance (NHBS) among men who have sex with men (MSM) in San Francisco in 2014 ( n = 410) using multivariable logistic regression models. We found that more than two in five MSM (41%) smoked or vaped. Smoking was greater for men of color (46% vs. 35%; p = .02); those with annual income below $50,000 (47% vs. 34%; p = .01); those without a college education (51% vs. 30%; p < .01); and the uninsured (55% vs. 38%; p = .04). In multivariable analyses, greater odds of smoking were observed among men living with HIV (adjusted odds ratio [aOR] = 1.7; 95% CI [1.00, 2.8]); men who reported cocaine use (aOR = 3.1; 95% CI [1.9, 5.0]), and men who reported greater number of alcohol drinks on a drinking day (aOR = 1.2; 95% CI [1.05, 1.29]). Lower odds of smoking were observed for men who completed college (aOR = 0.57; 95% CI [0.36, 0.88]). Greater odds of vaping were observed among men who reported meth use (aOR = 3.01; 95% CI [1.65, 5.50]). Lower odds of vaping were observed among men who completed college (aOR = 0.55; 95% CI [0.32, 0.98]). In conclusion, the prevalence of smoking and vaping among MSM is extremely high, particularly HIV-positive MSM. MSM who smoked and vaped were more likely to be racial and ethnic minorities, have lower socioeconomic status, and report more substance and alcohol use. These findings highlight the need to develop strategies effectively addressing the high rates of cigarette smoking and vaping among MSM, particularly among minority MSM and MSM living with HIV.

Use of Flavored E-Cigarettes Among Adolescents, Young Adults, and Older Adults: Findings From the Population Assessment for Tobacco and Health Study.

OBJECTIVES: The use of flavored electronic cigarettes (e-cigarettes) is common among e-cigarette users, but little is known about the potential harms of flavorings, the extent to which the concurrent use of multiple flavor types occurs, and the correlates of flavor type use. The objective of this study was to assess the types of e-cigarette flavors used by adolescent (aged 12-17), young adult (aged 18-24), and older adult (aged ≥25) e-cigarette users. METHODS: We assessed the prevalence of flavored e-cigarette use within the past month by flavor types and concurrent use of multiple flavor types among past-month e-cigarette users sampled during Wave 2 (2014-2015) of the Population Assessment for Tobacco and Health Study among 414 adolescents, 961 young adults, and 1711 older adults. We used weighted logistic regression models for the use of fruit-, candy-, mint/menthol-, tobacco-, or other-flavored e-cigarettes and concurrent use of multiple flavor types. Covariates included demographic characteristics, e-cigarette use frequency, cigarette smoking status, current use of other tobacco products, and reasons for e-cigarette use. RESULTS: The leading e-cigarette flavor types among adolescents were fruit, candy, and other flavors; among young adults were fruit, candy, and mint/menthol; and among older adults were tobacco or other flavors, fruit, and mint/menthol. Compared with older adults, adolescents and young adults were more likely to use fruit-flavored e-cigarettes (adjusted odds ratio [aOR] = 3.35; 95% confidence interval [CI], 2.56-4.38; and aOR = 2.31; 95% CI, 1.77-3.01, respectively) and candy-flavored e-cigarettes (aOR = 3.81; 95% CI, 2.74-5.28; and aOR = 2.95; 95% CI, 2.29-3.80, respectively) and concurrently use multiple flavor types (aOR = 4.58; 95% CI, 3.39-6.17; and aOR = 2.28; 95% CI, 1.78-2.91, respectively). CONCLUSIONS: Regulation of sweet e-cigarette flavors (eg, fruit and candy) may help reduce the use of e-cigarettes among young persons without substantially burdening adult e-cigarette users.

Dual use of electronic cigarettes and tobacco in New Zealand from a nationally representative sample.

OBJECTIVE: There is strong interest in the use of electronic cigarettes (e-cigarettes) globally. Not much is known about the dual use of e-cigarettes and combustible tobacco cigarettes, or if there are demographic differences among dual users and e-cigarette only users. This paper reports on the demographics of dual users and e-cigarette only users in New Zealand in a nationally representative sample. METHODS: The Health and Lifestyles Survey (HLS) is a biennial face-to-face in-house survey of New Zealand adults aged 15 years or over. The HLS was completed by 3,854 participants in 2016. RESULTS: There is clear evidence of significant dual use in the current sample: most current e-cigarette users (63.9%) were dual users. Respondents 45 years and older were twice as likely to be dual users as those aged 15 to 34 years. CONCLUSION: The current study found evidence for substantial dual use of e-cigarettes and combustible tobacco cigarettes among adult e-cigarette users, particularly among users aged 45 years and over. Implications for public health: Public health initiatives should provide clear advice that e-cigarettes should be used as a smoking cessation tool and not as a way to allow the consumption of combustible tobacco to continue.

Disaggregating Asian American and Native Hawaiian and Other Pacific Islander (AANHOPI) Adult Tobacco Use: Findings from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014.

INTRODUCTION: Tobacco studies often combine data for Asian American and Native Hawaiian and Other Pacific Islander (AANHOPI) subgroups, masking subgroup differences. This study describes tobacco use (ever use and past 30-day use) among some disaggregated AANHOPI subgroups. METHODS: Data are from Wave 1 of the 2013-2014 Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of civilian non-institutionalized adults and youth in the USA. The dataset contains a sample of 32,320 adults, of which 1623 identified as being of AANHOPI origin. Asian Americans further identified as being Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or other Asian. Those who identified as Native Hawaiian, Guamanian or Chamarro, Samoan, and Other Pacific Islander were combined into an NHOPI group. Tobacco measures included ever and past 30-day use of cigarettes, e-cigarettes, cigars (traditional cigar, cigarillos, filtered cigar), hookah, and smokeless tobacco including snus pouches, and pipe tobacco. Unadjusted and adjusted estimates for tobacco use are reported by AANHOPI membership and sex. RESULTS: In general, Asian Indians and Chinese had the lowest and NHOPI had the highest tobacco use prevalence compared to other AANHOPI subgroups. Males generally had higher prevalence compared to females. Prevalence varied by AANHOPI membership and tobacco product. Adjusted prevalence estimates were higher compared to unadjusted estimates for many subgroups, attenuating some unadjusted differences found between AANHOPI subgroups. DISCUSSION: Tobacco use varies by AANHOPI subgroup and product type. Unadjusted and adjusted analyses can be conducted as tobacco use differences in AANHOPI subgroups may be attributed to socio-economic status differences. Treating these distinct subgroups as a monolithic group may contribute to reliance on tobacco prevention and control strategies that may have limited impact on specific subgroups.

Electronic Cigarette Use and Attempts to Quit Smoking Cigarettes Among Adolescents in Taiwan.

PURPOSE: This study assessed the relationship between electronic cigarette (e-cigarette) use and attempts to quit smoking cigarettes by adolescent smokers in Taiwan. METHODS: Data were obtained from the cross-sectional Taiwan Global Youth Tobacco Survey conducted annually between 2014 and 2016, which included adolescents aged 12-18 years. The independent variable was e-cigarette use in the previous 30 days. The outcome variable was attempts to quit cigarette smoking during the previous 12 months. We controlled for the following variables: year of survey, gender, grade, monthly income/allowance, numbers of cigarettes per day, smoking status of parents and friends, use of other tobacco products, access to free tobacco products, assistance in quitting smoking, and exposure to anti-tobacco campaigns. RESULTS: Among cigarettes smokers, the prevalence of current e-cigarette use (in the previous 30 days) increased from 9.82% (2014) to 27.46% (2016), whereas attempts to quit smoking cigarettes decreased slightly from 71.31% (2014) to 70.59% (2016). Current e-cigarette use (OR = 1.21) was positively associated with attempts to quit cigarette smoking. Smokers who observed anti-tobacco media messages (OR = 1.12), attended antismoking classes (OR = 1.17), were influenced by warnings on cigarette packages (OR = 3.32), or received help to quit (OR = 3.11) were more likely to have attempted to quit cigarettes. CONCLUSIONS: We identified factors correlated with attempts to quit smoking, and recommend that the government continue monitoring electronic cigarette use, combat smoking in the media, provide antismoking classes, and expand health warnings on cigarette packages.

Electronic cigarette use and smoking cessation behavior among adolescents in China.

OBJECTIVE: China produces the majority of the world's electronic cigarettes (e-cigarettes) and e-cigarettes have become popular in the country, especially among young people. However, little is known about the characteristics of e-cigarette use in China and how it is associated with smoking cessation behavior. This study focuses on the adolescent group in China and examines their perception and use of e-cigarettes and the association with smoking abstinence. METHODS: We use a mobile app-based survey on smoking behavior conducted in November 2015 in China, and focus on a sample of 2042 adolescents aged between 12 and 18. Awareness, perception, use of e-cigarettes are examined as well as the behaviors of promoting e-cigarettes and of smoking cessation. A logistic regression is performed to test the association between e-cigarette use and smoking abstinence behavior. RESULTS: In 2015, nearly 90% of the surveyed adolescents in China were aware of e-cigarettes, while over a quarter of the respondents were ever users. The odds ratio for ever users of e-cigarettes to have tried to quit smoking conventional cigarettes was 1.60 that of never users. For those who tried to quit smoking, 36.02% indicated that they used e-cigarettes to help quit. However, only 13.52% of those who had used e-cigarettes to help quit smoking were successful in quitting. CONCLUSIONS: This study is one of the first empirical research on e-cigarette use among Chinese adolescents. E-cigarettes are widely known and quite popular among Chinese adolescents. As the association between e-cigarette use and smoking cessation behavior is less than clear, more empirical research is called for to help form evidence-based regulatory policy on e-cigarettes in China.