Cumulative Exposure to E-Cigarette Coupons and Changes in E-Cigarette Use Among U.S. Adults.

INTRODUCTION: Coupons are an effective, frequently used tobacco marketing strategy. This study examined prospective associations between cumulative exposure to e-cigarette coupons and changes in e-cigarette use among U.S. adults. METHODS: Data were from a representative U.S. adult cohort (n=19,824) in the Population Assessment of Tobacco and Health Study (waves [W] 2, 3, 4, and 5), collected from October 2014 to November 2019. Analysis was conducted in 2022. Four logistic regression models examined associations of a number of waves for which participants received e-cigarette coupons during W2-W4 with changes in e-cigarette use: W2 never use to W5 current use (initiation); W2 current nondaily use to W5 daily use (progression); W2 current use to W5 former use (cessation), and W2 former use to W5 current use (return-to-use). RESULTS: Overall, 66.1% of U.S. adults never used e-cigarettes, 10.6% currently used e-cigarettes, and 23.4% formerly used e-cigarettes at W2. The average number of waves for which participants received e-cigarette coupons during W2-W4 was 0.13: 0.10 among W2 individuals who never used e-cigarettes, 0.30 among individuals who currently used e-cigarettes on a nondaily basis, 0.50 among individuals who currently used e-cigarettes, and 0.17 among individuals who formerly used e-cigarettes. Receiving coupons at increased waves was associated with (1) greater odds of initiation (AOR=1.58, 95% CI=1.26-1.97); (2) lower odds of cessation (AOR=0.78, 95% CI=0.67-0.91); and (3) increased odds of return-to-use (AOR=1.39, 95% CI=1.14-1.69). Findings did not differ by W2 cigarette smoking status. CONCLUSIONS: E-cigarette coupons may encourage and sustain e-cigarette use. Policies restricting e-cigarette coupons may curb e-cigarette use.

Financial hardship during the COVID-19 pandemic and increased receipt of commercial tobacco discount coupons among US adults who use commercial tobacco.

INTRODUCTION: Many individuals experienced financial hardship during the COVID-19 pandemic; yet commercial tobacco (CT) sales increased in the USA. We examined how experiencing financial hardships relates to increased CT discount coupon reception during the pandemic. METHODS: A nationally representative sample of 1700 US adults who used CT during the 12 months prior to the survey were surveyed online during January to February 2021. Participants reported if they had received more discount coupons for various CT products during (compared with before) the pandemic. They also reported whether they experienced six different types of financial hardships since the pandemic, and the total number of hardships experienced was counted. Weighted multivariable logistic regressions were used to examine the associations between financial hardships and increased coupon reception, adjusting for demographics and CT product use. RESULTS: During the first 10-11 months of the pandemic, 21.3% of US adults who used CT during the 12 months prior to the survey reported receiving more CT discount coupons. Experiencing financial hardship during the pandemic was associated with higher odds of receiving more coupons for all types of CT products: every additional count of financial hardship was associated with higher odds of increased reception of discount coupons for all CT products (adjusted odds ratios ranging from 1.13 to 1.23 across products). CONCLUSIONS: Over one-fifth of US adults who used CT received more discount coupons during the pandemic. Those facing financial hardships had higher discount coupon reception, suggesting potential targeted marketing to financially vulnerable individuals by the tobacco industry.

Cumulative cigarette discount coupon exposure and trajectories of cigarette smoking: a longitudinal analysis in US adults.

INTRODUCTION: Exposure to cigarette discount coupons is associated with short-term increase in cigarette smoking; however, long-term impact is unclear. This study examined associations of cumulative exposure to cigarette coupons with trajectories of cigarette smoking in US adults. METHODS: Data were from the US Population Assessment of Tobacco and Health Study Adult Surveys (n=19 824; waves 2-5). We examined the number of waves participants received cigarette discount coupons/promotions during waves 2-4 and smoking behaviours at wave 5. Weighted logistic multivariable regression models were used, adjusting for wave 2 demographics and stratified by wave 2 smoking status. RESULTS: Among wave 2 adults who never smoked, each increment wave of exposure to cigarette discount coupons was associated with greater odds of wave 5 current smoking (adjusted OR (aOR)=2.09, 95% CI 1.24-3.52). Among wave 2 adults who smoked daily, each wave of coupon exposure was associated with lower odds of quitting smoking at wave 5 (aOR=0.67, 95% CI 0.62-0.73). Among wave 2 adults who had quit smoking, each increment wave of exposure was associated with greater odds of wave 5 current smoking (aOR=1.61, 95% CI 1.41-1.85). Additionally, women (vs men) and adults with lower socioeconomic status (SES) (vs higher SES) were more frequently exposed to cigarette coupons for a higher number of waves (p<0.05). DISCUSSION: Exposure to cigarette coupons exhibited a dose-response relationship with changes in cigarette smoking behaviours over time, promoting smoking progression and hindering smoking cessation especially among women and people with lower SES. Prohibiting these coupons can be an important tobacco control strategy.

Racial/Ethnic Disparities in Vicarious and Direct COVID-19-Related Discrimination and Vigilance.

INTRODUCTION: The high visibility of COVID-19-related discrimination underscores the importance of understanding the psychological harms associated with vicariously and directly experiencing such incidents. In this observational study, both vicariously and directly experienced COVID-19-related discrimination and their association with heightened concerns about discrimination and vigilance were examined in U.S. adults who use commercial tobacco. METHODS: Data were from a nationally representative sample of adults who currently or formerly used commercial tobacco products (N=1,700; mean age=43 years) from an online survey panel administered in January-February 2021 (analyzed in 2021-2022). Participants reported vicariously and directly experienced COVID-19-related discrimination, concern about experiencing such discrimination, and heightened vigilance. Weighted multivariable linear and logistic regression models were used to examine the associations among these variables. RESULTS: Overall, 69% of individuals reported exposure to vicarious COVID-19-related discrimination, and 22% reported directly experiencing COVID-19-related discrimination. Asian, Hispanic, and Black individuals reported higher levels of concern and vigilance than White individuals (p<0.05). Vicariously and directly experienced COVID-19-related discrimination was independently associated with concern about experiencing COVID-19-related discrimination in the entire sample and within each racial and ethnic group (p<0.05). This concern was associated with increased vigilance (p<0.05) and was stronger in those exposed to vicarious COVID-19-related discrimination than in those who were not (p<0.05). CONCLUSIONS: COVID-19-related discrimination may undermine the psychological well-being of those who are exposed to it vicariously as well as those who experience it directly and may also make individuals feel vulnerable and unsafe. Interventions to prevent and reduce the impact of COVID-19-related discrimination may have wide-reaching societal benefits.

Exploring the Experiences and Perceptions of Cigar Craving and Addiction among Young Adult Black Cigar Smokers.

Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, and perceived addiction from cigar smoking among a purposive sample of Black young adult cigar smokers (N = 40; 21-29 years). An iterative process was used to develop the codebook, and thematic analysis was used to capture findings based on the products predominantly used: cigarillos, large cigars, or blunts. Results suggest that while participants may share similar types of cravings and triggers (e.g., stress) across the use of these products, predominant blunt smokers reported more unique triggers related to relieving physical discomforts. While most participants reported cigars could be addictive to people in general, only a few perceived that they themselves were addicted. Participants who predominantly smoked cigarillos reported high perceived addiction to cigars, while those who predominantly smoked blunts reported low addiction. Education messages are needed to inform young Black adult cigar smokers about the risks and health symptoms of cigar addiction. These efforts may help increase cigar cessation seeking and reduce cigar addiction-related health consequences and disparities among Black populations.