Young adult peer crowds, e-cigarette advertising exposure, and e-cigarette use: Test of a mediation model.

BACKGROUND: Young people often make lifestyle choices or engage in behaviors, including tobacco product use, based on the norms of peer crowds they affiliate with. Peer crowds are defined as reputation-based peer groups centered around lifestyle norms (e.g., Hipster, Surfer, Hip Hop). This study examined the effects of peer crowd affiliation on e-cigarette use via increased exposure to e-cigarette advertising and increased social network e-cigarette use. METHOD: Data were collected from 1398 ethnically diverse young adults (Mean age = 22.3; SD = 3.2; 62% women) in six-month intervals over one year. Path analyses were used to test a mediation model in which advertising exposure and social network e-cigarette use at six-month follow-up were specified to mediate the effects of baseline peer crowd affiliation on current e-cigarette use at one-year follow-up. RESULTS: Affiliations with Popular-Social and Alternative peer crowds at baseline were associated with higher e-cigarette advertising exposure at six-month follow-up. Affiliation with Popular-Social peer crowd at baseline was associated with increased social network e-cigarette use at six-month follow-up. Affiliation with Popular-Social peer crowds at baseline was found to have a statistically significant indirect effect on increased e-cigarette use at one-year follow-up via increased e-cigarette advertising exposure at six-month follow-up. CONCLUSIONS: Better understanding Popular-Social peer crowds may be highly relevant for development of tailored media and other interventions for e-cigarette use prevention among young adults.

Cannabis use among cancer patients and survivors in the United States: a systematic review.

BACKGROUND: How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use. METHODS: PubMed and PsycINFO database searches were conducted between May 2022 and November 2022. Of the 1162 studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong (0.81). RESULTS: The majority (74%) of the studies were cross-sectional in design. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4.8% and 22%. The most common modes of cannabis intake were topical application (80%), smoking (73%), vaping (12%), and ingestion of edible products (10%). Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use. CONCLUSIONS: It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population.

The Betel Nut Intervention Trial (BENIT)-A Randomized Clinical Trial for Areca Nut and Betel Quid Cessation: Primary Outcomes.

BACKGROUND: Areca nut and betel quid (ANBQ) chewing is a widespread carcinogenic habit. The BENIT (ClinicalTrials-NCT02942745) is the first known randomized trial designed for ANBQ chewers. METHODS: We compared the intensive behavioral treatment intervention condition (IC) with the control condition (CC) in the BENIT and included a 5-stage early stopping rule. We report the primary analysis at stage 3. English-literate adults in Guam and Saipan who self-identified as ANBQ chewers with tobacco were enrolled between August 2016 and August 2020. IC participants (n = 88) received five in-person sessions over 22 days and a brochure containing quitting advice. CC participants (n = 88) received only the brochure. Participants were assessed at baseline and on day 22 of follow-up. Self-reported chewing status at day 22 was determined by a composite of two survey items with disparate wording and response options for cross-verification. RESULTS: Cessation rates were 38.6% (IC) and 9.1% (CC). Proportional hazards regression revealed a p = 0.0058, which met the Stage 3 criteria for significance, and an estimated reduction in ANBQ chewing for IC compared to the CC of 71% (95% CI: 41%-88%). CONCLUSIONS: Robust self-reported intervention effects at day 22 suggest that intensive cessation programs such as BENIT should be further developed and implemented on a larger scale.

A systematic review of experimental and longitudinal studies on e-cigarette use cessation.

BACKGROUND: The present study addresses the need to synthesize the findings in the current literature on e-cigarette use cessation. METHODS: PubMed, MEDLINE, and EMBASE databases were searched in November 2022 to systematically review studies focused on intentions, attempts, and successful e-cigarette use cessation. Three authors independently reviewed the full-texts of the initial pool of potentially eligible articles. Narrative data synthesis was conducted, and the risk of bias was evaluated. RESULTS: A total of 12 studies were selected for review, 7 of which were experimental and 5longitudinal. The majority of the studies focused on participants' intentions to quit e-cigarette use. The experimental studies varied in sample size, intervention type, and length of participant follow-up. Findings across the experimental studies were mixed, with only one full-fledged trial having examined cessation as an outcome. The experimental studies that assessed cessation outcomes utilized mobile technology as an intervention tool. Results from longitudinal studies indicated sociodemographic characteristics (gender, race/ethnicity), vaping frequency, and cigarette smoking status as predictors of intentions, attempts and e-cigarette use cessation. CONCLUSION: This review highlights the current paucity of methodologically rigorous research on e-cigarette use cessation. Our findings suggest that vaping cessation programs that employ mobile health technology to provide personalized cessation services may help promote intentions, attempts, and e-cigarette use cessation. Limitations of the current studies on vaping cessation include small sample sizes, heterogeneous cohorts that limit comparisons, and inconsistent ways of assessing vaping cessation. Future research needs to test long-term intervention effects using experimental and prospective designs among representative samples.

Ethnicity, Coronavirus Disease-Related Stress, and E-cigarette Use and Cigarette Smoking Among Young Adults: A Longitudinal Study.

INTRODUCTION: Research has rarely examined ethnic differences in exposure to coronavirus disease (COVID)-related stress in relation to smoking and e-cigarette use. AIMS AND METHODS: Using pre- and post-COVID data from a sample of predominantly Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) young adults, this study aimed to test the effects of ethnicity on cigarette smoking and e-cigarette use through exposure to COVID-related stress. Young adults from Hawaii who provided pre-COVID data in or before January 2020 were followed up with in March-May 2021. N = 1907 (mean age = 24.9 [SD = 2.9], 56% women) provided complete data relevant to the current analysis at both waves of data collection. Structural equation modeling was used to test the effects of ethnicity (white, Asian [eg, Japanese, Chinese], Filipino, NHPI, and other) on pre- to post-COVID changes in cigarette and e-cigarette use via effects on COVID-related stress. RESULTS: Relative to Asian young adults, members of all other ethnic groups (NHPI, Filipino, white, and other) indicated greater exposure to COVID-related stress. Higher levels of COVID-related stress were associated with increased dual-use status and increased current e-cigarette and cigarette use frequencies. Higher COVID-related stress mediated the effects of NHPI, Filipino, and other ethnicity on increased dual-use status. CONCLUSIONS: The current data indicate that young adults of vulnerable ethnic groups who experience higher COVID-related stress are at increased risk for dual use of cigarettes and e-cigarettes. IMPLICATIONS: The findings imply that tobacco use prevention and treatment efforts may need to pay increased attention to racial or ethnic groups that have experienced greater adverse impact of the COVID-19 pandemic.

Predictors of Discontinued E-Cigarette Use at One-Year Follow-Up in a Sample of Young Adults.

BACKGROUND: Currently, the research on factors associated with young adults' discontinuation of e-cigarette use behavior is limited. This study tested the predictors of self-reported e-cigarette abstinence at one-year follow-up among young adult baseline current e-cigarette users. The following variables were tested as predictors: demographics, cigarette smoking, e-cigarette use dependence, e-cigarette use duration, harm perceptions, and preferred aspects of e-cigarette use, including sensations, flavor, and device characteristics. METHODS: Data were provided at two time-points one year apart by 435 ethnically diverse young adults (M age = 22.3, SD = 3.1; 63% women) who reported current e-cigarette use at baseline. RESULTS: Approximately 42% of those who reported current e-cigarette use at baseline (i.e., 184 out of 435 participants) reported discontinuation of e-cigarette use at one-year follow-up. Results indicated that higher e-cigarette dependence, longer history of e-cigarette use, lower e-cigarette harm perceptions, greater preference for both menthol and sweet flavors, for open-pod-based devices, and for e-cigarette use sensations such as buzz, taste and smell of flavors, and throat hit at baseline were associated with lower likelihood of e-cigarette use discontinuation at one-year follow-up. CONCLUSIONS: Characteristics associated with nicotine (e.g., dependence) and flavors (e.g., taste and smell) appear to drive the continuation/discontinuation of e-cigarette use among young adults. Thus, cessation strategies may need to be developed with a focus on dependence and harm perceptions related to nicotine and flavors. Furthermore, better regulating open-pod-based devices and sweet-menthol flavors may help e-cigarette use prevention.

Peer Crowds and Tobacco Product Use in Hawai'i: A Qualitative Study.

BACKGROUND: Young adults often derive self-identity from affiliation with peer crowds, which may be defined as reputation-based peer groups centered around characterizable lifestyle norms. Little is known about peer crowds prevalent among Asian American, Native Hawaiian, and other Pacific Islander (AANHPI) populations and the peer crowds' normative tobacco and other substance use behavior. To address this gap in knowledge, this study conducted focus groups with young adult community college students. METHODS: Focus group discussions were conducted with a convenience sample of 42 young adults (Mean age = 21.5, SD = 2.7) recruited across community colleges on O'ahu, Hawai'i. The participants represented 60% women, 55% NHPI, and 29% Asian American. RESULTS: Results indicated the presence of a wide range of peer crowds in the population, which may be classified into the following seven categories prevalent in the literature: Regular, Academic, Alternative, Athlete, Geek, High Risk, and Popular. Several peer crowds within the Alternative, Athlete, Geek, High Risk, and Popular categories appeared to represent subcultures relevant for NHPI young adults. High-risk peer crowds were reported to be vulnerable to different types of substance use. Tobacco product use, particularly e-cigarette use or vaping, was noted to be characteristically present among Popular crowds and certain Athlete crowds. CONCLUSION: Tobacco and other substance use prevention interventions, such as mass media campaigns, may benefit from targeting high-risk peer crowds, especially those relevant for NHPI young adults, who are at high risk for tobacco and other substance use. E-cigarette use prevention interventions may benefit from paying close attention to vulnerable Popular and Athlete groups.

Relationships Between Depressive Symptoms, Anxiety, Impulsivity and Cigarette and E-cigarette Use Among Young Adults.

Depression and anxiety have been associated with cigarette use among young people. Higher impulsivity has also been associated with increased smoking behavior. However, relatively less is known about the associations between depression, anxiety, impulsivity and e-cigarette use and how these associations compare with the associations between depression, anxiety, impulsivity and cigarette smoking. In addition, little is known about how impulsivity influences the relationships between depression, anxiety, cigarette, and e-cigarette use. This study tested the hypothesis that higher depression and anxiety symptoms are associated with higher e-cigarette use and cigarette smoking in a similar way, and that these associations would be stronger among those with higher impulsivity. A sample of 2,622 young adults (18-25 year olds; 54% women) enrolled in 4-year and 2-year colleges in Hawai'i participated in a cross-sectional survey. Approximately 68% of the sample reported no use of either e-cigarettes or cigarettes, 13% reported only e-cigarette use, 9% reported only cigarette smoking, and 11% reported use of both. The study found that higher depressive and anxiety symptoms and higher impulsivity were significantly associated with current cigarette and e-cigarette use. For example, one unit increases in depression, anxiety, and impulsivity were associated with 34%, 17%, and 38% increased odds of e-cigarette use versus non-use, respectively. Impulsivity was found to significantly moderate the association between higher anxiety and higher cigarette smoking, such that the association was stronger among those with higher impulsivity. Impulsivity was not found to moderate any other association. Results suggest that tobacco product use prevention education should target children and young adults with higher internalizing symptoms, with particular attention to those who show higher impulsivity.

Trajectories of e-cigarette advertising exposure, e-cigarette use and cigarette smoking in a sample of young adults from Hawaii.

AIM: To test whether intrapersonal growth in e-cigarette advertising exposure over time is associated with growth in e-cigarette use and/or cigarette smoking. DESIGN: Longitudinal study using four waves of data were collected in 6-month intervals between 2018 and 2020. SETTING AND PARTICIPANTS: Participants were 2327 young adults recruited from colleges in Hawaii, USA. MEASUREMENTS: Data were collected on demographics, e-cigarette advertising exposure measured using the cued- recall method and recent (past 30-day) cigarette and e-cigarette use. FINDINGS: The average trajectory for e-cigarette advertising exposure over time was significant and upward [M slope = 0.18 (0.14-0.22), P < 0.0001]. However, average trajectories for e-cigarette [M slope = -0.08 (-0.18 to 0.02), P = 0.09] and cigarette [M slope = -0.14 (-0.30 to 0.02), P = 0.07] use were not. There were significant differences in individual level trajectories across participants for advertising exposure [σ2 = 0.12 (0.10-0.14), P < 0.0001], e-cigarette use [σ2 = 0.22 (0.14-0.30), and cigarette smoking (σ2 = 0.17 [0.09-0.25], P < 0.0001). Individuals with an increasing rate of advertising exposure showed an increasing rate of e-cigarette use [B = 0.63 (0.36-0.90), P < 0.0001). Neither initial level of, nor rate of change in, advertising exposure was significantly associated with cigarette smoking growth factors (P > 0.05). Higher initial level of e-cigarette use was associated with higher initial level of cigarette smoking [B = 0.89 (0.69-1.09), P < 0.0001] but decreased rate of cigarette smoking over time [B = -0.12 (-0.20 to -0.04) P = 0.003]. Rate of change in e-cigarette use was not associated with the rate of change in cigarette smoking (P > 0.05). CONCLUSIONS: Increased exposure to e-cigarette advertising appears to be associated with increased e-cigarette use but not with increased cigarette smoking. Higher initial level of e-cigarette use appears to be associated with higher initial level of cigarette smoking but may be associated with a decreasing rate of cigarette smoking over time.

Ethnicity and the mechanisms of point-of-sale e-cigarette marketing's influence on behavior: A longitudinal study.

Objective: To test the mechanisms by which exposure to point-of-sale (POS) e-cigarette marketing mediate the relationship between an ethnic minority group highly vulnerable for tobacco product use, namely Native Hawaiian/Other Pacific Islander (NHPI), and increased future e-cigarette use through explicit (positive outcome expectancies) and implicit (spontaneous positive reactions) pathways. Method: Four waves of data were collected in 6-month intervals from 2,327 multiethnic young adults (Mage = 21.2, SD = 2.2; 54% women) enrolled across two 4-year and four 2-year colleges belonging to a University system in Hawaii. POS e-cigarette marketing exposure was assessed with an objective measure involving store visit patterns and store audits, as well as a measure of self-reported exposure. Spontaneous reactions were assessed with an implicit measure, namely Affect Misattribution Procedure (AMP). Path analyses were used to test the hypotheses. Results: In a model employing the objective measure of POS exposure, a statistically significant pathway was found from NHPI ethnicity to increased current e-cigarette use at Wave 4 mediated through increased POS exposure at Wave 2, and increased affect regulation expectancies at Wave 3. Similar indirect effects on prospective e-cigarette use were found for Asian ethnicity. The dual process model of the effects of POS exposure on e-cigarette use was not fully supported, although the implicit measure was found to independently predict e-cigarette use. Conclusions: Differential exposure to POS marketing may explain some of the ethnic disparities in tobacco product use behavior such as e-cigarette use. POS marketing may affect e-cigarette use behavior mainly through the explicit pathway, notably affect regulation expectancies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exposure to e-cigarette content on social media and e-cigarette use: An ecological momentary assessment study.

This pilot ecological momentary assessment (EMA) study tested the associations between exposure to anti-e-cigarette content on social media and e-cigarette use behavior. For exposure to anti-e-cigarette posts, participants were asked to follow the study account on Instagram, on which anti-e-cigarette content were posted regularly. In addition, we assessed participants' exposure to pro-e-cigarette content in their daily lives and examined the effects of such exposure on behavior. Participants were 29 diverse young adult current e-cigarette users (18-30 year olds; 54% women), who provided data 3 times daily, for 3 weeks via a mobile phone based EMA application. Relative to no exposure, exposure to anti-e-cigarette content was associated with decreased recent e-cigarette use frequency at the next assessment time-point (p < 0.05; 2-tailed). In addition, a statistically significant concurrent association was found between exposure to pro-e-cigarette content (relative to no exposure) and higher e-cigarette use (p < 0.05; 2-tailed). The current data are some of the first to show that exposure to anti-e-cigarette content on social media may have real time effects on decreased e-cigarette use among young adults as they go about their daily lives. Policies and efforts designed to regulate pro-e-cigarette and promote anti-e-cigarette content on social media may help reduce e-cigarette use among young people.

The Effects of E-Cigarette Use on Alcohol and Marijuana Abuse Symptoms in an Ethnically Diverse Sample of Young Adults.

BACKGROUND: We examined e-cigarette use as a prospective predictor of alcohol and marijuana abuse symptoms in a sample consisting of Native Hawaiian and Other Pacific Islander (NHPI), Filipino, Asian (i.e., Japanese, Chinese, Korean), and White young adults. NHPI represent a highly vulnerable group with regard to substance use and are severely understudied. METHODS: Data were collected from 1463 young adults (M age = 22.2, SD = 3.2; 59.5% women) enrolled across community colleges in Hawai'i at two time-points six months apart. RESULTS: Higher frequency of e-cigarette use at baseline was predictive of higher alcohol (B = 0.06, SE = 0.02, p < 0.01) and marijuana (B = 0.06, SE = 0.02, p < 0.01) use problems at six-month follow up, adjusting for baseline cigarette smoking, problem alcohol/marijuana use, sensation seeking, and demographic variables. Ethnicity was found to significantly moderate the relationship between baseline e-cigarette use and problem marijuana use later, such that White and NHPI ethnicities were particularly vulnerable to the effects of e-cigarette use on problem marijuana use. CONCLUSION: NHPI are often combined with Asians in national surveys, which obfuscates the higher risks faced by NHPI compared with groups that are routinely classified as Asians (e.g., Chinese, Japanese, Filipinos). The current research highlights the NHPI's vulnerability in terms of the effects of e-cigarette use on marijuana and alcohol abuse symptoms.

Heat-not-burn Tobacco Products and the Increased Risk for Poly-tobacco Use.

Objectives: In this study, we tested the use of ecigarette, cigarette, and dual use of both as predictors of heat-not-burn (HNB) tobacco product use onset among young adults, and examined common predictors of smoking cessation as predictors of HNB product use. Methods: We collected data from 2229 young adults [mean age = 21.1 (SD = 2.1); 55% women] in Hawaii, at 2 time-points 6 months apart. Results: Current cigarette-only use was the strongest concurrent predictor of HNB product use, followed by dual use, and ecigarette-only use. Among HNB product never users at Wave 1, dual and ecigarette-only use at Wave 1 significantly predicted HNB product use onset at Wave 2. Among cigarette smokers who had never used an HNB product at Wave 1, current use of ecigarette for help with smoking cessation predicted increased odds of HNB product use at 6-month follow-up. Conclusions: Although promoted as a safer alternative for exclusive cigarette smokers, HNB products may increase the risk of dual or poly-tobacco product use among young adults, including current exclusive e-cigarette users. Surveillance of HNB product use as a modified risk tobacco product may need to consider the effects of HNB products on poly-tobacco use among young people.

Social media's influence on e-cigarette use onset and escalation among young adults: What beliefs mediate the effects?

As an extension of a previous cross-sectional study, this study employed prospective data to test positive outcome expectancy beliefs as mediators of social media's influence on e-cigarette use progression among young adults. Self-report data were collected from 2327 young adult college students (Mean age = 21.2; SD = 2.1; 54% women) between 2017 and 2019, every 6-month, at 3 time-points. Structural equation modeling was used to test the mediational models. Among baseline never e-cigarette users, higher affect regulation expectancies-e.g., beliefs that e-cigarette use results in feeling good, reduced boredom and stress-mediated the effects of higher baseline social media e-cigarette exposure on e-cigarette use onset one year later. Among baseline lifetime e-cigarette users, higher positive sensory, positive "smoking" experience, and affect regulation expectancy beliefs mediated the effects of higher social media e-cigarette exposure at baseline on increased current e-cigarette use one year later. E-cigarette content on social media may persuade young adults to try e-cigarettes by imparting the sense that e-cigarettes make one feel good and help reduce stress. E-cigarette content on social media that promote e-cigarette flavors and e-cigarettes as cleaner and a socially more acceptable alternative to cigarettes may work to escalate e-cigarette use among experimenters. Efforts to prevent e-cigarette use onset and escalation may need to target the outcome expectancy beliefs influenced by social media.

Predictors of marijuana vaping onset and escalation among young adults.

BACKGROUND: Little is known about factors that influence marijuana vaping among young people. We examined cigarette, e-cigarette and marijuana use experiences, social network characteristics and exposure to direct e-cigarette marketing as predictors of marijuana vaping initiation and escalation. METHODS: One-year prospective data were collected between 2017 and 2019 from 2327 young adults (Mean age = 21.2; SD = 2.1; 54 % women) attending 2-year and 4-year colleges in Hawaii. RESULTS: Among participants who were never marijuana users at baseline, being a dual user of cigarette and e-cigarette at baseline was the strongest predictor of marijuana vaping initiation, followed by baseline cigarette-only and e-cigarette-only use. Higher prevalence of regular marijuana users in one's social networks, but not e-cigarette users or cigarette smokers, significantly predicted marijuana vaping initiation a year later. Among baseline current e-cigarette users and lifetime marijuana users, higher presence in social networks of individuals who frequented vape shops at baseline was a significant predictor of increased current marijuana vaping at one-year follow-up. CONCLUSIONS: Dual use of cigarette and e-cigarette and greater presence in social networks of marijuana users and people who frequent vape shops appear to be robust predictors of marijuana vaping onset and escalation among young adults. In addition to promoting e-cigarette use prevention/cessation, efforts to control marijuana vaping may need to consider promoting smoking prevention/cessation and the effects of increasing prevalence of marijuana use.

Rationale and design of a randomized, controlled, superiority trial on areca nut/betel quid cessation: The Betel Nut Intervention Trial (BENIT).

BACKGROUND: Areca nut (AN) is the seed endosperm of the Areca catechu L. palm and a Group 1 carcinogen chewed by 10-20% of the world population. AN is often chewed with Piper betle L. leaf, slaked lime, and tobacco to form a betel quid (BQ). The negative health effects associated with AN/BQ consumption warrant the need for an evidence-based cessation program. However, systematic research on AN/BQ cessation is rare. METHODS/DESIGN: The Betel Nut Intervention Trial (BENIT; trial #NCT02942745) is a randomized controlled trial designed to test the efficacy of an intensive AN/BQ cessation program. The trial is ongoing in Guam and Saipan with adult chewers who include tobacco in their BQ. Enrolled participants are assessed for their primary (chewing status) and secondary (saliva bio-verification) outcome at baseline, 22 days, and 6 months. Participants randomized into the control arm receive an educational booklet while those randomized into the intervention arm receive the educational booklet and a 22-day cessation program modeled after a smoking cessation program and led by trained facilitators. Information on chewing behavior (history, reasons for chewing, and AN/BQ composition and dependency) are collected. The intervention effectiveness is assessed using the logistic mixed model to compare cessation status between randomization groups. DISCUSSION: AN/BQ chewing affects a large population of people, many of whom live in low and moderate income countries in the Asia-Pacific region. Although the BENIT focuses on chewers in Guam and Saipan, it has the potential for greater regional and global importance.

Social media e-cigarette exposure and e-cigarette expectancies and use among young adults.

A vast majority of U.S. young adults use social media such as Facebook and Instagram daily. Research suggests that young adults are commonly exposed to e-cigarette-related marketing or user-generated content on the social media they use. Currently, however, there is limited empirical evidence as to how social media e-cigarette exposure is associated with e-cigarette use beliefs and behavior. In particular, limited evidence exists to support the proposition that social media e-cigarette exposure is uniquely associated with e-cigarette use, even after adjusting for the effects of e-cigarette use in young adults' in-person or 'offline' social networks. This study was conducted to test the hypotheses that 1) social media e-cigarette exposure is associated with e-cigarette use outcome expectancies and current e-cigarette use; and 2) the association between social media and e-cigarette use is linked via outcome expectancies. We collected cross-sectional data from a sample of 470 young adult college students in Hawaii. Hypotheses were tested by fitting a structural equation model to the data. The model accounted for the associations of demographic variables, cigarette smoking history, as well as e-cigarette use in individuals' actual social networks with expectancies and behavior. Results indicated that social media e-cigarette exposure was associated with current e-cigarette use indirectly through two of the four positive outcome expectancies examined, namely, positive "smoking" experience and positive sensory experience. We discuss the implications of the findings in the context of tobacco control efforts.

Young adult e-cigarette use outcome expectancies: Validity of a revised scale and a short scale.

The revised youth e-cigarette outcome expectancies measure adds new items informed by recent qualitative research with young adult e-cigarette users, especially in the domain of positive "smoking" experience. Positive "smoking" experience represents beliefs that use of e-cigarettes provides outcomes associated with a better "smoking" alternative: for example, an alternative that is more socially approved, more suitable for indoor use, and that provides a safer means of enjoying nicotine. In addition, we tested a short, 8-item version of the measure which may be more easily incorporated into surveys. We tested the validity of the revised measure, both long and short versions, in terms of factor structure and associations of the expectancy factors with current e-cigarette use, e-cigarette use susceptibility, and e-cigarette use dependence. Participants were young adults (N=470; 65% women; mean age=20.9, SD=2.1). Results replicated the findings of the previous study as well as highlighted the importance of the added domain of positive "smoking" experience and the validity of the short scale. Furthermore, results showed that positive outcome expectancies are strongly associated with e-cigarette use dependence. The long and short versions of the revised youth e-cigarette outcome expectancies scale appear to be valid and useful for application not only among cigarette smokers and e-cigarette users but also among never smokers and never e-cigarette users.

Comparison of Measures of E-cigarette Advertising Exposure and Receptivity.

OBJECTIVES: We tested how various measures of e-cigarette advertising exposure and receptivity are related to each other and compare to each other in their associations with e-cigarette use susceptibility and behavior. METHODS: Cross-sectional data were collected from young adult college students (N = 470; Mage = 20.9, SD = 2.1; 65% women). Measures of e-cigarette advertising exposure/receptivity compared included a cued recall measure, measures of marketing receptivity, perceived ad exposure, liking of e-cigarette ads, and frequency of convenience store visit, which is considered a measure of point-of-sale ad exposure. RESULTS: The cued-recall measure was associated with e-cigarette use experimentation but not current e-cigarette use. Marketing receptivity was associated with current e-cigarette use but not e-cigarette use experimentation. Liking of e-cigarette ads was the only measure associated with e-cigarette use susceptibility. Frequency of convenience store visit was associated with current e-cigarette use but not e-cigarette use experimentation or susceptibility. CONCLUSION: Inclusion of multiple measures of marketing exposure and receptivity is recommended for regulatory research concerning e-cigarette marketing. Marketing receptivity and cued recall measures are strong correlates of current and ever e-cigarette use, respectively.

Short-term fluctuations in motivation to quit smoking in a sample of smokers in Hawaii.

BACKGROUND: Despite its potential for usefulness in informing the development of smoking cessation interventions, short-term fluctuations in motivation to quit is a relatively understudied topic. OBJECTIVES: To assess the prevalence of smokers' day-to-day fluctuations in motivation to quit, and to assess associations of day-to-day fluctuations in motivation to quit with several established cessation-related variables. METHODS: A cross-sectional survey was administered to smokers in Hawaii (N = 1,567). To assess short-term fluctuations in motivation to quit smoking, participants were asked to respond "True" or "False" to the statement: "My motivation to quit smoking changes from one day to the next." Other items measured desire to quit smoking, intention to quit, confidence in quitting, cigarette dependence, and other cessation-related variables. RESULTS: "My motivation to quit smoking changes from one day to the next" was endorsed as true by 64.7% of smokers, and false by 35.3%. Analyses revealed that smokers who indicated fluctuating motivation were significantly more interested in quitting as compared to smokers without fluctuations. Fluctuations in motivation to quit also were associated with greater confidence in quitting, lesser cigarette dependence, and more recent quitting activity (all p < .01). CONCLUSIONS: Day-to-day fluctuations in motivation to quit are common. Day-to-day fluctuations in motivation to quit are strongly associated with higher motivation to quit, greater confidence in future quitting, and other positive cessation-relevant trends.