E-Cigarette Use and Transition in Adult Smoking Frequency: A Longitudinal Study.

INTRODUCTION: The relationship between e-cigarette use and cigarette smoking is the subject of ongoing debate. There is limited research on e-cigarette use and changes in the frequency of cigarette smoking. This study examines whether the frequency of e-cigarette use is associated with changes in cigarette smoking behavior among U.S. adults. METHODS: The study used data (n=20,558) from Waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health, analyzed in 2019. Multivariable multinomial logistic regression assessed the association between e-cigarette use at Wave 1 and change in cigarette smoking frequency between Waves 1 and 2. RESULTS: Every day cigarette smokers who used e-cigarettes some days (OR=1.95, 95% CI=1.27, 2.98) and every day (OR=3.37, 95% CI=1.78, 6.36) in Wave 1 had significantly higher odds of switching to some days cigarette smoking in Wave 2. Every day smokers who used e-cigarettes every day in Wave 1 had higher odds of becoming former cigarette smokers in Wave 2. Likewise, e-cigarette use at baseline among former cigarette smokers was associated with higher odds of switching to some days cigarette smoking (experimental e-cigarette use: OR=5.43, 95% CI=2.13, 10.72; some days e-cigarette use: OR=4.78, 95% CI=2.13, 10.72). In addition, experimental smokers who were also some days e-cigarettes users in Wave 1 had significantly lower odds of switching to experimental former smokers. CONCLUSIONS: Although e-cigarette use may reduce cigarette smoking frequency among continuing smokers, findings suggest that e-cigarette use may be associated with cigarette smoking relapse among former smokers.

Sociodemographic Differences in Secondhand Smoke Exposure in the United States.

Background. Socioeconomic disparities in secondhand smoke (SHS) exposure exist among nonsmokers. The present study examined the prevalence and socioeconomic disparities of both objective and self-reported measures of SHS exposure in various indoor environments among U.S. nonsmokers. Method. Data were drawn from the 2013-2014 and 2015-2016 National Health and Nutrition Examination Survey. The prevalence of objective measures of SHS (nonsmokers with serum cotinine levels of 0.05-10 ng/mL) and the self-reported SHS exposure status in restaurants, cars, and homes other than their own were examined for the overall population as well as by sociodemographic characteristics. Multivariable logistic regression analyses were used to assess the association between sociodemographic characteristics and SHS exposure measures. Results. The prevalence of self-reported SHS exposure in restaurants, cars, and homes other than one's own decreased significantly between 2013-2014 and 2015-2016. We found higher odds of the objective measure of SHS exposure among non-Hispanic Blacks (aOR 2.07, 95% confidence interval [1.93, 2.81]) and males (aOR 1.12, confidence interval [1.05, 1.18]), while lower odds were found among Mexican Americans, other Hispanics, and those who had family income greater or equal to the poverty level. Compared to non-Hispanic Whites, the non-Hispanic Black group had higher odds of SHS exposure in restaurants and homes other than their own. Age was positively associated with self-reported SHS exposure measures but not the objective SHS measure. However, age was negatively associated with SHS measures in the adult sample (aged ≥ 20 years). Conclusions. Findings suggest that although SHS exposure may be decreasing in specific at-risk populations, socioeconomic disparities still exist.

Bullying Victimization and e-Cigarette Use among Middle and High School Students.

BACKGROUND: Bullying has been associated with several adverse health outcomes, including substance use. However, little is known about the association between bullying and e-cigarette use. This study examined the association between bully victimization and the frequency of e-cigarette use. METHODS: Data from the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey were used (N = 49,543). The target population consists of Canadian students enrolled in grades 7-12. Multivariable logistic regression models were used to examine the association between bullying victimization status and e-cigarette use. RESULTS: Among the students included in the study, 14.1% were bullied less than once a week. Bullying victimization was statistically significantly associated with higher odds of any e-cigarette use in the last 30 days. Likewise, those bullied daily or almost daily were more likely to use e-cigarettes more frequently compared to students not bullied. We found a statistically significant difference in analysis stratified by sex, with female bullying victims having higher odds of all measures of e-cigarette use. CONCLUSIONS: Bullying victims were significantly more likely to use an e-cigarette, and findings appeared to vary by sex. Female bullying victims had a higher likelihood of e-cigarette use.

Single cigarette purchasers among adult U.S. smokers.

Cigarette smoking remains the leading preventable cause of morbidity and mortality. The purchase of single cigarettes, known as loosies, allows for a more affordable cost than a pack of cigarettes. Many of the existing studies on loose cigarettes have used a small non-generalizable sample. This study examined the sociodemographic characteristics of loosie purchasers among adult cigarette smokers in the United States. Data from the 2006/07-2014/15 Tobacco Use Supplement to the Current Population Survey were analyzed. The sociodemographic characteristics of loosie users were examined by multivariable logistic regression. In 2014-2015, approximately 5.4% of adult smokers reported purchasing loosies compared to 3.7% in 2006-2007. Men (OR 1.22, 95% CI 1.10-1.35), non-Hispanic Blacks (OR 3.30, 95% CI 2.89-3.77), Hispanics (OR 1.97, 95% CI 1.67-2.32), and those living in a metropolitan area (OR 1.16, 95% CI 1.02-1.33) had significantly higher odds of single cigarette purchase. Single cigarette use also varied by age, marital status, employment, and geographic region. Menthol cigarette smokers had higher odds of purchasing loosies compared to non-menthol smokers. Likewise, cigarette quit intention was significantly associated with odds of buying loosies. The prevalence of single cigarette purchases among smokers appears to be lower in a national sample compared to previous estimates reported in specific populations. However, certain subpopulations were more likely to purchase a single cigarette and may contribute to persistent disparities among racial and ethnic minorities. Preventing the sale of loosies may improve the health outcomes of underserved communities, specifically those with low socioeconomic status.

Rural-urban differences in cannabis detected in fatally injured drivers in the United States.

While there is a vast literature on rural and urban differences in substance use, little is known in terms of cannabis positive drug tests among fatally injured drivers. In the present study, we examined rural-urban differences in cannabis detected in fatally-injured drivers. Data were drawn from the 2015-2017 Fatality Analysis Reporting System. Multivariable logistic regression was performed to examine rural-urban differences in the percentage of cannabis detected in fatally-injured drivers. Analyses were stratified by rural-urban classification and sex. A positive cannabis test in fatally-injured drivers was more prevalent in urban locations. Compared to fatally-injured drivers in rural locations, urban drivers had higher odds of a positive test for cannabinoids (aOR: 1.21, 95% CI 1.14-1.28). Non-Hispanic Black drivers had higher odds of testing positive for cannabinoids (aOR: 1.43, 95% CI 1.31-1.55). Those aged at least 25 years had lower odds of a positive test for cannabinoids. Drivers involved in a weekend nighttime crash (aOR: 1.14, 95% CI 1.03-1.26) and weekday nighttime (aOR: 1.15, 95% CI 1.05-1.26) had higher odds of testing positive for cannabinoids compared to drivers involved in a weekend daytime crash. Results showed significant rural-urban differences in the prevalence of cannabis detected in fatally-injured drivers.

Trends in Binge and Heavy Drinking among Adults in the United States, 2011-2017.

Background: Alcohol misuse is one of the leading causes of preventable death in the United States each year. Objectives: In the present study, we examine trends in binge and heavy drinking. We used data from the 2011-2017 Behavioral Risk Factor Surveillance System. For trend analyses, we used logistic regression for heavy drinking and binge drinking variables. Joinpoint model analysis was conducted to identify where significant changes in trend occurred. Results: The trend analysis indicated that the overall prevalence of binge drinking decreased significantly from 18.3% in 2011 to 16.0% in 2014, then increased significantly to 17.0% in 2017. This trend was also found for heavy drinking, with a significant decrease from 6.6% in 2011 to 5.8% in 2014, then increased significantly to 6.2% in 2017. This trend persisted for certain subgroups; males, females, White participants, and the 35-54 age group all had a similar decrease in prevalence followed by an increase from 2014-2017. Conclusions: Overall, our results indicate a recent significant increase in both binge and heavy drinking among the general population.

A Trend Analysis of Age of First Marijuana Use Among High School Students in the United States From 1991 to 2017.

Background. Marijuana is the most commonly used illicit drug in the United States. There has been a rapidly changing marijuana policy environment and increased acceptability related to marijuana in the United States. How the changing environment will potentially influence adolescents age of initiation remains unknown. While much of extant literature has primarily focused on current marijuana use, less is known about age of first use. This study examined trends in adolescents' age of first marijuana use in the United States. Method. Data were drawn from the 1991 to 2017 Youth Risk Behavior Survey. We used linear regression for age of first use as a continuous variable, and logistic regression for marijuana use before the age of 15 years as a dichotomous variable. Joinpoint regression analysis identified where significant changes in trend occurred. Results. Results showed that the mean age of first marijuana use increased significantly between 1991 and 2017. Males had a younger age of first use than females. Between 1991 and 1997, there was an increasing trend in the prevalence of marijuana use before the age of 15 years in all adolescents and in subgroups for males, females, all races, and 9th and 10th grades. After 1997, a significant downward trend was found in all adolescents. Conclusions. Our results do not indicate an overall decreasing trend of age of first use among the general adolescent population. Results show a downward trend in the use of marijuana before the age of 15 years since 1997.

Disparities in adult cigarette smoking and smokeless tobacco use by sexual identity.

BACKGROUND: While there have been reductions in rates of tobacco use in the general population in recent years, rates remain high among sexual minority populations (SMP). Prior studies often group SMP as one category due to limited data. This study examined the association between sexual identity status and tobacco use (cigarette and smokeless tobacco use) among U.S. adults. METHODS: Data from the 2014-2017 Behavioral Risk Factor Surveillance System were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, other, not sure, and heterosexual or straight) and tobacco use. A propensity score analysis was conducted to address potential imbalance among group characteristics. RESULTS: Lesbian/gay and bisexual groups had significantly higher odds of being an every day smoker (OR = 1.83, 95 % Confidence Interval (CI) 1.59-2.10; OR = 1.36, 95 % CI 1.19-1.55, respectively) and current smoker (every day or some days) (OR = 1.71, 95 % CI 1.52-1.93; OR = 1.44, 95 % CI 1.29-1.62, respectively) compared to straight adults. In terms of smokeless tobacco products, lesbian and gay adults had lower odds of every day and current use. However, significant differences were found in the separate analysis conducted for males and females. While gay and bisexual males had lower odds of smokeless tobacco use, lesbians had significantly higher odds when compared to the straight population. Bisexual females were also more likely to be current users of smokeless tobacco. CONCLUSIONS: Significant heterogeneity in tobacco use was found among sexual minority subgroups. Findings demonstrate the importance of subgroup analysis of SMP. These results have implications for prevention and cessation targeting.

County Smoke-Free Laws and Cigarette Smoking Among U.S. Adults, 1995-2015.

INTRODUCTION: Tobacco use remains the leading cause of preventable death worldwide. Though research on smoke-free policies in the U.S. exists at the state or national level, there is limited evidence on such policies at the county level. This study examined the association between changes in county-level comprehensive smoke-free laws and smoking behavior among U.S. adults. METHODS: Data were used from the 1995/1996 to the 2014/2015 Tobacco Use Supplement to the Current Population Survey, analyzed in 2019. Changes in county smoke-free law population coverage over time were used as a natural experiment. Quasi-experimental analyses were performed to examine the association between changes in county-level comprehensive smoke-free laws and smoking behavior (smoking status and number of cigarettes smoked). RESULTS: During the study period, current smoking prevalence decreased from 21.6% to 11.9%. Specifically, the prevalence of every day smoking decreased from 17.1% to 9.1% and some days smoking decreased from 4.4% to 2.9%. The number of cigarettes smoked per day for every day smokers decreased from 18.5 to 13.6, and from 5.9 to 4.1 for those who smoked some days. Comprehensive smoke-free legislation was associated with lower odds of cigarette smoking (AOR=0.76, 95% CI=0.74, 0.79). Adults living in counties with comprehensive smoke-free policies smoked fewer cigarettes per day both for every day smokers (ß= -1.55, p<0.0001) and some days smokers (ß= -0.79, p<0.0001). CONCLUSIONS: County smoke-free policies in the U.S. may have contributed significantly to the reduction in smoking prevalence as well as the reduction in the number of cigarettes smoked among continuing cigarette smokers.

Trends in cigarette smoking among American Indians and Alaska Natives in the USA: 1992-2015.

PURPOSE: While smoking prevalence may be declining in the general population, health disparities in tobacco use remain a public health priority. This study examined national, sociodemographic, and geographic trends in American Indians and Alaska Natives (AIs/ANs) smoking prevalence from 1992/1993 to 2014/2015. Additionally, correlates of cigarette smoking were examined among this group. METHODS: Data were drawn from the 1992-2015 Tobacco Use Supplement to the Current Population Survey. Cochran-Armitage tests were used to assess changes in the prevalence of smoking over time in the population, as well by sociodemographic characteristics. Multivariable logistic regression was conducted to examine the correlates of cigarette smoking for AIs/ANs in 2014/2015. RESULTS: The trend analysis indicated that the prevalence of smoking, among AIs/ANs, decreased significantly from 39.1% in the 1992/1993 cycle to 20.9% in the 2014/2015. This decrease was seen in both males and females, with the prevalence of smoking decreasing from 43.6% and 35.4%, respectively, in 2006/2007 to 23.8% and 18.3% in 2014/2015. The decreasing trend was also found for all subgroups, except for the 55+ age group. Multivariable analysis showed higher odds of smoking among males, those with low income compared to those with median or higher income, and those living in non-metropolitan areas. Those aged 25-54 were more likely to be smokers compared with the 55+ age group. CONCLUSIONS: Results indicate a recent decrease in AIs/ANs smoking prevalence, although these populations still experience a high prevalence of smoking compared to the general population. Our findings highlight the need for a comprehensive tobacco control strategy that includes working with stakeholders within the AI/AN community.

Marijuana use and subsequent cigarette use among U.S. adolescents: A longitudinal study.

BACKGROUND: The extant literature on the relationship between marijuana and tobacco among youth is mixed. The present study examined the temporal association of marijuana use with subsequent cigarette use in a nationally representative sample of U.S. adolescents. METHODS: We used data from Waves 1, 2 and 3 of the Population Assessment of Tobacco and Health. A propensity score method was used to address imbalance between marijuana ever and non-ever users. Logistic regressions were used to examine the temporal associations of marijuana ever use at Wave 1 on cigarette use at Waves 2 and 3 among youth that were classified as never cigarette users at Wave 1. RESULTS: Among the 422 youth marijuana ever users at Wave 1, 15.5% reported subsequent past 12-month (P12M) cigarette use and 8.2% reported subsequent past 30-day (P30D) cigarette use at Wave 2. Of the 7924 youth never marijuana users at Wave 1, 3.5% reported P12M cigarette use and 1.4% reported P30D cigarette use. Youth marijuana ever users at Wave 1 were more likely to report P12M cigarette use (aOR = 5.11; 95% CI 2.91-8.95) and P30D cigarette use (aOR = 6.14; 95% CI 2.89-13.04) at Wave 2. CONCLUSIONS: Our findings suggest that youth marijuana ever users were more likely to report subsequent P12M cigarette use and P30D cigarette use. Given the known health effects related to both products, findings suggest there is a need for continued monitoring of both marijuana and cigarette use among adolescents, especially in a rapidly changing regulatory environment.

E-cigarette Retail Licensing Policy and E-cigarette Use Among Adolescents.

PURPOSE: The present study evaluated whether Pennsylvania's 2016 law requiring a retail license for the sale of e-cigarettes was associated with adolescent e-cigarette use. METHODS: Data were drawn from the 2015-2017 Youth Risk Behavior Surveillance System. We examined the prepolicy and postpolicy change in e-cigarette use for the state with the retail licensing requirement (Pennsylvania) compared with control states (New York and Virginia). RESULTS: Results showed that e-cigarette licensing policy was significantly associated with e-cigarette use. E-cigarette use among Pennsylvania adolescents reduced by 5.2 percentage points in 2017 when compared with New York adolescents, and a corresponding 21.6% decrease from its baseline prevalence level in 2015. Similarly, there was a 7.4 percentage point decrease in e-cigarette use in Pennsylvania when compared with Virginia (30.7% relative decrease from the baseline prevalence). CONCLUSIONS: An e-cigarette retail licensing requirement may be a useful policy tool in reducing e-cigarette use among adolescents.

Positive drug test trends in fatally-injured drivers in the United States from 2007 to 2017.

BACKGROUND: The last two decades have seen tremendous changes in the U.S. environment surrounding drugs. Driving under the influence of drugs is a growing public health hazard. The present study examined trends in drug involvement in fatally-injured drivers in the U.S. METHODS: Data were drawn from the 2007-2017 Fatality Analysis Reporting System. Cochran-Armitage tests were performed to assess the statistical significance of changes in the yearly prevalence of positive drug tests in fatally-injured drivers over time. In addition, analyses were stratified by sex, race, and age. RESULTS: The yearly prevalence of positive drug tests in fatally-injured drivers increased significantly from 20.7% in 2007 to 30.7% in 2017, with results showing a higher prevalence among males, those aged 21-44, and Whites. The gap between Blacks and Whites narrowed in 2017. There was a decline in the yearly prevalence in all age groups between 2016 and 2017, although the decrease in the 21-44 age group was much smaller than other age groups. Among drivers who tested positive for drugs, 34.6% had a blood alcohol concentration (BAC) above the threshold of per se evidence for impaired driving, and 63% had a BAC below the threshold. CONCLUSIONS: Our results indicate that the overall yearly prevalence of fatally-injured drivers who tested positive for drugs increased significantly from 2007 to 2017, with similar results found for subgroups. Findings further highlight that drugged driving remains a public health priority, and more action is needed to stem this disturbing trend.

Exposure to secondhand smoke in vehicles among Canadian adolescents: Years after the adoption of smoke-free car laws.

Exposure to secondhand smoke (SHS) can result in several adverse health consequences. SHS concentrations in vehicles can significantly exceed levels present in other enclosed spaces. Years after the adoption of smoke-free car laws, this study examined the prevalence of exposure to SHS in vehicles among adolescents. Data were utilized from the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey (n = 48,444). The prevalence of exposure to SHS in cars was estimated by grade level and demographic characteristics. The results showed a gradient by grade level in exposure to SHS with students in upper-grade levels reporting a higher prevalence of SHS in cars. SHS varied by province, with the lowest rate found in British Columbia (15.6%) and the highest in Saskatchewan (36.9%). The provinces with laws that extend protections to older children also had high rates of SHS exposure among students in upper-grade levels. Students exposed to SHS were more likely to engage in risky behaviors, including the use of marijuana, alcohol, cigarettes, and e-cigarettes. Despite laws prohibiting smoking in vehicles carrying children, SHS prevalence remains high. While enforcement of these laws may be challenging, persuasion campaigns highlighting that children are especially vulnerable to the health risks of SHS may be beneficial.

Assessing trends and healthy migrant paradox in cigarette smoking among U.S. immigrant adults.

The healthy migrant paradox suggests that immigrants to developed countries are, on average, healthier than the native born of the host country, with some finding that health advantages diminish after 10-20 years. This study examined trends in immigrant cigarette smoking trends, as well as smoking by the length of residence in the U.S. Data were drawn from the 1995-2015 Tobacco Use Supplement to the Current Population Survey (n = 140,254). Cochran-Armitage tests were used to assess changes in the prevalence of smoking over time in the population, as well by demographic characteristics. Multivariable logistic regression was used to compare cigarette smoking differences between immigrants' length of residence in the U.S. and the native-born population. The prevalence of immigrants' cigarette smoking significantly decreased from 15.0% in 1995/96 to 6.9% in 2014/15. Cigarette smoking rates for males and females significantly decreased from 20.8% and 9.1%% in 2007, respectively, to 10.4% and 3.6% in 2017. Differences in cigarette smoking appeared to have narrowed over time by the length of stay in the U.S. Multivariable analysis showed that immigrants had significantly lower odds of cigarette smoking (length of stay ≤5 years, Odds Ratio = 0.40, 95% Confidence Interval = 0.32-0.51; 6-10, OR = 0.39, CI =0.31-0.49; 11-20, OR = 0.39, CI =0.34-0.45; 20+, OR = 0.47, CI =0.43-0.53) compared to the native-born population. Findings show that immigrants consistently have lower smoking rates than native born, and this healthy behavior advantage did not appear to diminish based on years living in the U.S.

Cigarette, smokeless tobacco, and alcohol use among transgender adults in the United States.

BACKGROUND: Research suggests that sexual minority adults face disparate risks for poor health outcomes. However, prior research on transgender populations has been limited by small and nonprobability samples and has potentially masked important differences between transgender subgroups. We examined disparities in cigarette, smokeless tobacco, and alcohol consumption by transgender and cisgender adults. METHODS: 2014-2017 Behavioral Risk Factor Surveillance System data were used. Multivariable logistic regressions examined differences in cigarette, smokeless tobacco, and alcohol use between cisgender adults and transgender sub-identities: male to female (MTF), female to male (FTM), and gender nonconforming. RESULTS: Cigarette and smokeless tobacco use were higher among transgender adults. The gender nonconforming subgroup reported more binge and heavy drinking. In a multivariable logistic analysis, higher odds of smokeless tobacco use were found for all transgender sub-identities compared to cisgender females. The gender nonconforming group had higher odds of heavy drinking (AOR = 2.09, 95% CI 1.14-3.82) and binge drinking (AOR = 1.94, 95% CI 1.25-3.02) compared to cisgender females. The MTF subcategory was more likely to binge drink (AOR = 1.88, 95% CI 1.44-2.46) compared to cisgender females. The FTM subcategory had lower odds of binge drinking (AOR = 0.49, 95% CI 0.33-0.73) compared to cisgender males. CONCLUSIONS: Significant heterogeneity in smokeless tobacco and alcohol use were found among transgender subgroups, particularly when compared to cisgender females. Our findings demonstrate that it is important to consider sub-identities in both the transgender population and in the reference cisgender population.

Cigarette smoking, e-cigarette use, and sexual identity among high school students in the USA.

Although tobacco use has decreased in the general population in recent years, smoking remains high among subpopulations. This study examined whether sexual identity is associated with cigarette smoking and e-cigarette use among high school students. Data were drawn from the US Youth Risk Behavior Surveillance System (n = 28811). We grouped participants according to sexual identity status. Propensity score matching technique was used to address covariate imbalance among sexual identity groups. Subgroup analyses were performed for male and female students. Of the four sexual identity groups analyzed in this study, bisexual adolescents had significantly higher odds of cigarette smoking (cigarette smoking, OR, 1.61; 95% CI, 1.24-2.08; cigarette smoking for ≥ 10 days, OR, 1.79; 95% CI, 1.28-2.51; cigarette smoking for ≥ 20 days, OR, 2.04; 95% CI, 1.38-3.03). Further, in a sex-based subgroup analysis, results showed significant differences, with bisexual females more likely to smoke cigarettes and use e-cigarettes for ≥ 20 days compared with heterosexual female adolescents.Conclusions: Sexual identity status is strongly associated with cigarette smoking and e-cigarette use. Female bisexual adolescents have an increased risk of cigarette smoking and e-cigarette use for ≥ 20 days. While tobacco control policies have been effective in reducing cigarette use in the general population, targeting policy toward sexual minorities is an important consideration. What is Known: • Sexual minority groups face a disproportionate amount of stress and have a heightened risk of substance use. • Methodological concerns exist in the extant literature, including limited data at the national level. What is New: • Propensity score matching was used to account for imbalances in sexual identity subgroups, and findings show significant heterogeneity in cigarette and e-cigarette use among sexual minority high school students. • Sexual identity status is strongly associated with cigarette smoking and e-cigarette use, especially among bisexual identity female subgroup.

Frequency of E-cigarette use and cigarette smoking among Canadian students.

The emergence of electronic nicotine delivery systems (commonly referred to as e-cigarettes) has created an ongoing public health debate and concerns, especially in regards to adolescents. The present study examined associations between the frequency of e-cigarette use and cigarette smoking among school students. Data on students (grades 7-12) was obtained from the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey (n = 51,661). Multivariable logistic regression analyses were conducted to examine associations between the frequency of e-cigarette use and smoking. Subgroup analyses were performed for male and female students. Among those who reported any cigarette smoking in the past 30 days, 55% reported e-cigarette use at least once in the last 30 days. Additionally, 17% reported e-cigarette use for 21-30 days among those who smoked cigarettes for at least 21 days. Multivariable logistic regression analysis showed e-cigarette use was associated with higher odds of cigarette smoking, especially among more frequent e-cigarette users. Those who used an e-cigarette 21-30 days had higher odds of cigarette smoking (smoked cigarette at least once AOR = 4.83, CI = 3.33-7.01; at least 11 days AOR = 3.73, CI = 2.40-5.80; at least 21 days AOR = 3.39, CI = 2.16-5.34). Findings suggest that those who smoked cigarettes at least once in the past 30 days had a higher frequency of e-cigarette use.

Adolescent Dual Use Classification and Its Association With Nicotine Dependence and Quit Intentions.

PURPOSE: Electronic cigarettes (e-cigarette) use is rapidly increasing in the U.S., especially among adolescents. A significant number of adolescents use both cigarettes and e-cigarettes, often referred to as dual use. We used a new classification of dual use, taking into account the frequency of use of both products. In addition, we examined the association between dual use with time to first cigarette after waking (a nicotine dependence measure) and quit intention. METHODS: Data were drawn from the 2015-2018 National Youth Tobacco Survey. We grouped participants by dual use frequency. Multivariable logistic regression was used to examine the association of dual use frequency with nicotine dependence and quit intention. RESULTS: Different categories of dual users varied in demographic characteristics and beliefs on the harms of cigarette smoking and e-cigarette use. Compared with cigarette-only smokers, significantly higher odds of nicotine dependence were found for high-frequency e-cigarette dual users (within 5 minutes of awakening, odds ratio [OR]: 1.67, 95% confidence interval [CI], 1.07-2.62; within 30 minutes, OR: 1.61, 95% CI, 1.15-2.27), high-frequency cigarette dual users (5 minutes, OR: 2.85, 95% CI, 1.76-4.63; within 30 minutes, OR: 4.14, 95% CI, 2.96-5.80), and high-frequency dual users (5 minutes, OR: 4.46, 95% CI, 2.88-6.91; 30 minutes, OR: 3.94, 95% CI, 2.43-6.42). In addition, high-frequency e-cigarette dual users had significantly lower quit intention compared with both cigarette-only smokers and low-frequency dual users. CONCLUSIONS: Findings highlight the need for a standard, granulated classification of dual user, as important characteristics may vary between different categories. Future studies on dual use should consider categorizing dual use into the four classifications described in this study.

Overweight and Obesity among Sexual Minority Adults in the United States.

There is evidence that sexual minority populations have a potentially heightened risk of poor health outcomes due in part to the discrimination they may face. In the present study, we examined whether overweightness and obesity vary by sexual minority subgroup using a large, nationally representative sample. Data were drawn from 2014-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys (n = 716,609). We grouped participants according to sexual identity (straight, lesbian or gay, bisexual, and other/don't know/not sure). The propensity score matching technique was used to address covariate imbalance among sexual identity groups. In addition, subgroup analyses were performed for both males and females. Compared to straight adults, lesbian females had significantly higher odds of being overweight (OR (odds ratio) 1.33; 95% CI (confidence interval) 1.17-1.53), whereas gay males had significantly lower odds (OR 0.66; 95% CI 0.59-0.73). Similarly, lesbians were more likely to be obese (OR 1.49; 95% CI 1.31-1.70), whereas gay men had significantly lower odds of obesity (OR 0.77; 95% CI 0.69-0.86) when compared to straight adults. Bisexual females had significantly higher odds of being overweight (OR 1.21; 95% CI 1.10-1.34) and obese (OR 1.43; 95% CI 1.29-1.59), whereas bisexual males showed no significant difference. Our results strengthen previous findings and further highlight the need for research by sexual minority subgroup.