The youth e-cigarette epidemic: updates and review of devices, epidemiology and regulation.

Adolescent e-cigarette use constitutes a major public health challenge that has reversed the steady progress made in the past three decades to reduce youth tobacco use in the United States (U.S.). Although the prevalence of e-cigarette use has declined in the past two years, 24% of 12th grade students and 8.9% of 8th grade students in 2021 used e-cigarettes or engaged in vaping of any kind in the prior 30 days. The current e-cigarette landscape is dominated by discrete and stylish pod-based e-cigarettes with varying capacity for customized nicotine delivery, vapor concealment, and child-appealing e-liquid flavors. E-cigarettes continue to evolve rapidly with innovative technology as manufacturers seek loopholes in regulatory efforts and to maximize existing marketing opportunities. Regulatory efforts so far have focused largely on marketing restrictions with enforcement decisions prioritizing smoking cessation potential of e-cigarettes for adult smokers over risk of nicotine addiction in adolescents. Disposable e-cigarette products advertising synthetic nicotine and menthol-containing products remain on the market and continue to gain popularity among adolescents. This article describes e-cigarette devices, provides an overview on epidemiology of U.S. adolescent e-cigarette use, and reviews the existing federal, state, and local e-cigarette regulations with future recommendations for stakeholders.

Creation and validation of a citywide pediatric asthma registry for the District of Columbia.

OBJECTIVE: To create and validate a citywide pediatric Asthma Registry to improve the care and outcomes of children and adolescents in Washington, DC through data-driven quality improvement (QI). METHODS: All available electronic health record data from inpatient and outpatient domains of Children's National Hospital were aggregated from an existing enterprise data warehouse. Inclusion criteria included asthma relevant ICD-10 codes over the prior 24 months. Available Asthma Registry measures include patient demographics, ambulatory visits, hospital admissions, persistent asthma diagnoses, and prescription of controller medications. Data capture was validated using US Census data and current asthma prevalence estimate of the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS: The registry identified 15,991 DC children and adolescents with asthma aged 0-17 years, inclusive, at the end of 2020. This was 14.2% higher than the estimate of 14,001 children derived from BRFSS. Characteristics of those in the registry included: mean age of 9.5 (1.4) years, 57.9% male, 72.3% Black, and 66.7% publicly insured. Over the prior 24 months, 30.3% had ≥1 emergency department visit, and 10.5% had ≥1 hospital admission. Controller medications were prescribed for 59.6% of children with persistent asthma. Rates varied by sampled primary care practice sites. CONCLUSIONS: A population-level pediatric asthma registry captures more children and adolescents with asthma in DC then a BRFSS-derived estimate, and provides city-wide measures of asthma-related utilization. The registry allows for stratification by primary care practice locations and asthma characteristics, supporting the design, implementation, and evaluation of QI projects at the practice, health system, and population levels.Supplemental data for this article can be accessed at publisher's website.

Socioeconomic well-being in early adulthood among repeat versus one-time teenage mothers.

Teenage mothers are known to be at elevated risk for poor socioeconomic outcomes in adulthood. However, little is known about the socioeconomic outcomes of mothers who bear multiple children during the teenage years (repeat teenage mothers) compared to one-time teenage mothers. This study examines socioeconomic outcomes in the mid- to late 20s of repeat teenage mothers compared to one-time teenage mothers in a national U.S. sample. Repeat teenage mothers were less likely to graduate high school and more likely to receive public assistance and experience material hardship than one-time teenage mothers in their mid- to late- 20s. Lower educational attainment plus the responsibility of caring for multiple children as a young mother may make it difficult for repeat teenage mothers to secure economic stability. Additional supports may be necessary to improve long-term socioeconomic outcomes of repeat teenage mothers.

Adolescent E-cigarette Users at Highest Risk of Cigarette Smoking Intention.

Objectives: Adolescent e-cigarette users are at risk of developing smoking intention, an established predictor of conventional cigarette smoking. In this study, we identify subgroups of adolescent e-cigarette users who are most likely to intend to smoke conventional cigarettes. Methods: Cross-sectional data on 1357 8th and 10th grade e-cigarette users who had never smoked conventional cigarettes were obtained from 2014-2017 Monitoring the Future Surveys. We conducted latent class analysis to identify subgroups of adolescent e-cigarette users; through latent class regression analysis, we examined the association between subgroup membership and smoking intention. Results: We identified 3 subgroups of adolescent e-cigarette users: socially-protected (56.6%), peer-driven (29.8%), and market-vulnerable (13.6%). The peer-driven class reported the highest number of peers who smoke and the lowest proportion of friends who strongly disapproved of daily cigarette smoking. They were significantly more likely than the socially-protected and market-vulnerable classes to have smoking intention (AOR=2.46; 95% CI 1.84-3.28, and AOR=2.29; 95% CI 1.48-3.53, respectively). Conclusion: Our findings provide insights on the constellation of risk and protective factors that contribute to smoking intention among adolescent e-cigarette users. It highlights peer influence as an important area of emphasis for adolescent smoking prevention programs.

Smoking Intention and Progression From E-Cigarette Use to Cigarette Smoking.

OBJECTIVES: To investigate whether the prospective association between electronic cigarette (e-cigarette) use and cigarette smoking is dependent on smoking intention status. METHODS: Waves 2 and 3 data of the Population Assessment of Tobacco and Health (PATH) Study, a US nationally representative prospective cohort study of tobacco use. Data were collected in 2014-2015 (wave 2) and 2015-2016 (wave 3) and analyzed in 2019. RESULTS: At wave 2, 12.8% of adolescent never-smokers of conventional cigarettes had intention to smoke and 8.5% had ever used an e-cigarette. At wave 3, 3.2% had ever smoked a cigarette. Both smoking intention and ever using e-cigarettes at wave 2 were positively associated with cigarette smoking at wave 3 (adjusted odds ratio [aOR] = 3.03; 95% confidence interval [CI] = 1.97-4.68, P < .001; aOR = 4.62, 95% CI = 2.87-7.42, P < .001, respectively). The interaction between smoking intention and ever using e-cigarettes was significant (aOR = 0.34, 95% CI = 0.18-0.64, P < .01). Among adolescents who had expressed intention to smoke conventional cigarettes at wave 2, the odds of cigarette smoking at wave 3 did not significantly differ for e-cigarette users and never e-cigarette users (aOR = 1.57; 95% CI 0.94-2.63; P = .08). Among adolescents who had no intention to smoke at wave 2, e-cigarette users, compared with never e-cigarette users, had >4 times the odds of cigarette smoking (aOR = 4.62; 95% CI 2.87-7.42; P < .0001). CONCLUSIONS: E-cigarette use is associated with increased odds of cigarette smoking among adolescents who had no previous smoking intention. E-cigarette use may create intention to smoke and/or nicotine use disorder that lead to onset of cigarette smoking.

Adolescent Risk Behavior: Differentiating Reasoned And Reactive Risk-taking.

Although explanatory models of adolescent risk behavior have predominantly focused on adolescents' limited ability to self-regulate impulsive and/or reward-driven behavior (reactive risk behavior), recent arguments suggest that a significant proportion of adolescent risk behavior may actually be strategic and planned in advance (reasoned risk behavior). The present study evaluates hypothesized predictors of reasoned versus reactive risk behavior using self-reported and neurocognitive task data from a large, diverse adolescent sample (N = 1266 participants; N = 3894 risk behaviors). Participants' mean age was 16.5 years (SD = 1.1); 56.9% were female, 61.9% White, 17.1% Black, 7.0% Hispanic, and 14.1% other race/ethnicity; 40% were in 10th grade, 60% in 12th grade. As hypothesized, reasoned risk behavior (compared to reactive risk behavior) was associated with higher levels of sensation seeking, better working memory, greater future orientation, and perceiving risk behavior to be more beneficial than risky. These results support the distinction between reasoned and reactive risk behavior as meaningful subtypes of adolescent risk behavior and challenge prevailing frameworks that attribute adolescent risk behavior primarily to poor response inhibition.

Adolescent Smoking Susceptibility in the Current Tobacco Context: 2014-2016.

OBJECTIVES: We examined perceptions and behaviors associated with smoking susceptibility among adolescents in the current tobacco landscape. METHODS: Participants were 8th and 10th grade never-smokers of conventional cigarettes (N = 19,853) from Monitoring the Future surveys (2014-2016). Using weighted multivariable logistic regression, we examined risk factors for smoking susceptibility: alternative tobacco product use (e-cigarettes, large cigars, little cigars/cigarillos, and flavored little cigars/cigarillos), ownership of tobacco promotional items (TPIs), access to cigarettes, perceived influence of antismoking advertisements, and perceived addictiveness of conventional cigarette smoking. RESULTS: Among never-smokers of conventional cigarettes, 16.7% were susceptible to smoking, 6.2% were past 30-day alternative tobacco product users, and 3.5% owned TPIs. Alternative tobacco product use, ownership of TPIs, and easy access to cigarettes were associated with increased likelihood of smoking susceptibility. Perceived great influence by antismoking ads and higher perceived addictiveness of conventional cigarette smoking were associated with lower odds of smoking susceptibility. CONCLUSION: Alternative tobacco product use, ownership of TPIs, easy access to cigarettes, low influence by antismoking ads, and low perceptions of the addictiveness of conventional cigarettes are significant and actionable risk factors for smoking susceptibility among today's adolescents.

Perceptions of the Harm and Addictiveness of Conventional Cigarette Smoking Among Adolescent E-Cigarette Users.

PURPOSE: Although existing evidence indicates that e-cigarette use is a risk factor for cigarette smoking initiation, mechanisms of this association are not yet known. E-cigarette users perceive e-cigarette use to be less harmful relative to conventional cigarettes, but their absolute perceptions of addictiveness of conventional cigarette smoking are unknown. This study examines how e-cigarette users compare with nonusers (non-e-cigarette users/nonconventional cigarette smokers), conventional cigarette smokers, and dual users on perceptions of harm and the addictiveness of conventional cigarette smoking and on other known predictors of cigarette smoking such as peer smoking, influence of antismoking ads, and risk-taking propensity. METHODS: National samples of 8th- and 10th-grade students from 2014 and 2015 (N = 14,151) were obtained from the Monitoring the Future Study. Multivariate logistic regression models were used to examine relationships between adolescent smoking status and perceptions of harm and the addictiveness of conventional cigarette smoking while controlling for potential confounders. RESULTS: E-cigarette users had lower perceptions of the addictiveness of conventional cigarette smoking compared with nonusers but higher than cigarette smokers and dual users. E-cigarette users reported lower influence by antismoking ads, more conventional cigarette-smoking peers, and greater risk-taking propensity than nonusers. E-cigarette users and cigarette smokers did not differ in their perceived harm of conventional cigarette smoking or in their risk-taking propensity. CONCLUSIONS: E-cigarette users' attitudes and perceptions regarding conventional cigarette smoking may leave them vulnerable to becoming conventional cigarette smokers. Future studies should explore the prospective relationship between smoking-related perceptions of conventional cigarette smoking among e-cigarette users and the onset of cigarette smoking.

Historical declines and disparities in cigarette coupon saving among adolescents in the United States, 1997-2013.

Exposure to cigarette coupons is associated with smoking initiation and likelihood of cigarette purchase among adolescents. Some adolescents who are exposed to cigarette coupons take a step further by choosing to save or collect these coupons, a further risk factor for cigarette smoking. This study examines historical trends and disparities in cigarette coupon saving among adolescents in the United States from 1997 to 2013. National samples of 10th and 12th grade students (n=129,111) were obtained from Monitoring the Future surveys in 1997-2013. Prevalence of lifetime and current cigarette coupon saving was estimated in each year in the overall adolescent population, and in race/ethnicity, parent education level, sex, and urban/rural subgroups. Prevalence of lifetime and current cigarette coupon saving was then estimated in each year based on smoking status. Prevalence of cigarette coupon saving has decreased dramatically among adolescents; only 1.2% reported currently saving coupons in 2013. However, disparities in cigarette coupon saving remain with prevalence higher among rural, White, and low parental education level students. Adolescent smokers continue to save coupons at high rates; 21.2% had ever saved coupons and 6.9% currently saved coupons as of 2013. Despite overall declines in adolescent cigarette coupon saving, existing sociodemographic disparities and the considerably high prevalence of coupon saving among adolescent smokers suggest that cigarette coupons remain a threat to smoking prevention among youth. Additional research is needed to further elucidate longitudinal associations between cigarette coupon saving and smoking initiation and maintenance among adolescents.