E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors.

BACKGROUND: Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use. METHODS: An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17/04/2023 and 04/11/2023. RESULTS: A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants' smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant's smoking status, the mother's smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value < 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%). CONCLUSION: This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students' knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.

E-cigarette use reasons and associated e-cigarette use dependence among college students: A longitudinal examination.

OBJECTIVE: Previous studies have established an understanding of reasons for e-cigarette use and associated e-cigarette use patterns such as use frequency, yet the critical extension to associated e-cigarette dependence outcome remains under-researched. This study used longitudinal data to examine whether the reasons for e-cigarette use predict a higher/lower level of e-cigarette dependence. METHODS: This study recruited college students who were current e-cigarette users from Fall 2019 to Fall 2020 (four semesters) at three public universities in the Midwest and South of the U.S. Those who participated for at least two semesters were included (N = 366). Data were collected using a structured questionnaire. E-cigarette use dependence was assessed using the Penn State Electronic Cigarette Dependence Index. A linear mixed model with a random intercept and a random slope was conducted to examine the longitudinal association between reasons for e-cigarette use and dependence, controlling for demographics and other covariates. RESULTS: Participants who used e-cigarettes for relaxation (ß = 0.63, p < 0.05) and due to their good taste (ß = 0.63, p < 0.05) had a higher level of e-cigarette dependence. Participants using e-cigarettes for experimental purposes had a lower level of e-cigarette dependence (ß = -1.21, p < 0.01). CONCLUSIONS: These findings highlight the importance of addressing e-cigarette use reasons and their relationship to e-cigarette dependence. Prevention and intervention efforts aimed at developing more effective strategies should consider the various e-cigarette use reasons associated with dependence risks, such as enhancing awareness of the use dependence risk related to good taste of e-cigarettes and use for relaxation, as well as incorporating early screenings for use.

[Analysis of prevalence status and influencing factors of e-cigarette use among secondary school students in Heilongjiang Province].

Objective: To describe the current situation and influencing factors of e-cigarette use among secondary school students in Heilongjiang Province to provide evidence for formulating provincial youth e-cigarette prevention and control strategies. Methods: A multi-stage stratified cluster probability sampling method was adopted in 2021, with 8 340 students in 180 classes from 56 primary and high schools in 10 monitoring districts and counties in Heilongjiang Province. The students in the selected classes filled out a unified questionnaire by themselves. SAS 9.4 software was used for data cleansing, sample weighting, and analysis. Chi-squared tests were used to compare the differences between groups, and a two-level logistic regression model was used to analyze the influencing factors of e-cigarette use among secondary school students. Results: A total of 8 329 survey questionnaires were included in the analysis. The prevalence rates of ever and current e-cigarette use among secondary school students in Heilongjiang Province were 18.27% and 5.46%, respectively. In terms of ever e-cigarette use, the rate of boys (23.94%) was higher than that of girls (12.35%). The rate of vocational high school students (39.18%) was higher than that of general high school students (24.11%) and than that of junior school students (11.27%). In terms of current e-cigarette use, the rate of boys (7.08%) was higher than that of girls (3.76%). The rate of vocational high school students (14.56%) was higher than that of general high school students (7.70%) and than that of junior school students (2.67%). The rates of ever and current e-cigarette use were relatively higher in each subgroup, including "weekly allowance more than 40 Yuan" "one of the student's parents, friends or teachers was smoker" "smoked cigarettes now" and "saw e-cigarette advertisements". A two-level logistic regression model showed that the following factors were the influencing factors of current use of e-cigarettes among secondary school students, including gender, whether they were current cigarette smokers, the smoking status of their close friends, if they saw teachers smoked in the school, noticed e-cigarette advertisements, and e-cigarette addictive cognition. Conclusions: The prevalence rates of ever and current e-cigarette use among secondary school students in Heilongjiang Province were high. E-cigarette advertisements, the smoking status of their close friends, and whether they saw teachers smoking in the school were the main factors affecting e-cigarette use among secondary school students in Heilongjiang Province. It is necessary to focus on constructing smoke-free environments and increase health education related to e-cigarette knowledge on risk in developing a smoke-free campus in the whole province.

Disparities in Electronic Cigarette Use: A Narrative Review.

The prevalence of electronic cigarette use has been declared an epidemic by the U.S. Surgeon General in 2018, particularly among youth aged 18-24 years old. Little is known about the differential use of e-cigarettes by different groups. PubMed, Cochrane, and Google Scholar were used to find relevant articles. A total of 77 articles were included. The extant literature reveals disparities in e-cigarette use by race/ethnicity and sexuality/gender. There are conflicting conclusions regarding disparities by socioeconomic status.

The Evolution of a Pediatric Public Health Crisis: E-cigarette or Vaping-Associated Lung Injury.

E-cigarettes and vaping products were first introduced in the United States around 2007, and quickly grew in popularity. By 2014, e-cigarettes had become the most commonly used tobacco product among youth in the United States. An e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak was identified by the Centers for Disease Control and Prevention (CDC) in 2019, with many cases in the adolescent population. The CDC opened a national database of cases and launched a multistate investigation; reported cases reached a peak in September 2019. The CDC investigation found that a vaping liquid additive, vitamin E acetate, was strongly linked to the EVALI outbreak but determined that the decline in cases was likely multifactorial. Due to decreased cases and the identification of a potential cause of the outbreak, the CDC stopped collecting data on EVALI cases as of February 2020. However, e-cigarettes and vaping products have continued to be the most popular tobacco product among youth, though state and national regulations on these products have increased since 2016. While pediatric case series and studies have shown differences in clinical presentation and medical histories between pediatric and adult EVALI cases, the fact that cases are no longer tracked at a national level limits necessary information for pediatric clinicians and researchers. We describe the available literature on the diagnosis, pathophysiology, treatment, and outcomes of EVALI in the pediatric population, and provide clinical and public health recommendations to facilitate prevention and management of EVALI specific to pediatrics.

Does sensation-seeking behavior influence the patterns of flavored e-cigarette use? A cross-sectional study among Indonesian adolescents and young adults.

BACKGROUND: The variety of available flavors in e-cigarettes may be a driver for young people to start using these products. The objectives of our study were to examine the relationship between sensation-seeking behavior and e-cigarette use, and to identify the predictors of flavor use patterns among adolescents in Indonesia. METHODS: Students aged 15 to 24 years participated from randomly selected high schools and universities in Indonesia. Participants answered questions about their demographic data, e-cigarette use, conventional cigarette use, and sensation-seeking. Flavor preferences were identified from eight different flavor categories. Multivariate multinomial regression analysis was employed to predict conventional cigarette and e-cigarette use among students. A latent class analysis was conducted to determine the number of latent classes of flavor use. RESULTS: One thousand six hundred high school and university students, with a mean age of 18.2 years (SD 2.19), were recruited between March and August, 2023. Conventional cigarette use in the past 30 days was higher (16.3%) compared to e-cigarette use (13.3%, p = 0.017), with approximately 8.5% of students were being dual users. Higher levels of sensation-seeking significantly increased the odds of being a current e-cigarette user (OR = 2.54, 95%CI 1.99-3.25) and a current conventional cigarette smoker (OR = 2.38, 95%CI 1.85-3.07). Three groups of flavor classes were identified: 1) primarily menthol flavor users (14%), who had a strong association with current conventional cigarette use; 2) experimenters, who mostly preferred fruit-flavored e-cigarettes (76%); and 3) the multi-flavor user group (10%), who had a higher sensation-seeking tendency. CONCLUSIONS: Flavors, especially menthol and fruit flavors, attract youth, broaden the e-cigarette audience and are particularly appealing to high sensation-seekers. Banning these flavors could significantly deter e-cigarette initiation among youth.

Investigating the spatial and temporal variation of vape retailer provision in New Zealand: A cross-sectional and nationwide study.

Smoking rates have decreased in Aotearoa New Zealand in recent years however, vaping has shown a dramatic upward trend especially among young people; up to 10% of young New Zealanders are now regular vapers. Importantly, the long-term health consequences for their future life are largely unknown. The accessibility of vape retailers is important, particularly in relation to the youths' daily activities and places such as schools where they spend a considerable amount of time and socialise. Despite this, we know little about the spatial patterning of vape retailers and even less of their socio-spatial patterning around schools. This ecological study utilised data from the New Zealand Specialist Vape Retailers register on nationwide vape retailer locations and combined them with whole-population sociodemographic characteristics and primary and secondary school data. We identified the prevalence of vape retailers and their spatial distribution by area-level deprivation, ethnicity and urban-rural classification by using descriptive statistics and (spatial) statistical modelling on the area-, school- and individual students-level (using disaggregated data on students). We found that almost 97% of all vape retailers are located within 1,600m (∼20-min walk) and 29% within 400m (∼5-min walk) of schools. Our research also identified increasing inequities by deprivation and ethnicity both for the overall population and particularly for students in the most deprived areas who experience a disproportionate presence and increase of new vape store retailers that disadvantage schools and students in these areas. This difference was particularly prominent for Pasifika populations in major urban environments.

A four-year longitudinal analysis examining the effects of e-cigarette advertisements and disparities among youth with internalizing problems.

BACKGROUND: Prior research indicates a direct, short-term effect of e-cigarette advertising on e-cigarette use among youth. This study seeks to investigate the long-term effects of e-cigarette advertisements and disparities in exposure among adolescents with different levels of internalizing problems. METHODS: Panel data of the Population Assessment of Tobacco and Health (PATH) Study Waves 3-5 (2015-2019) were analyzed. Youth aged 12-17 who were non-e-cigarette users at the time of Wave 3 were included (n = 4,678). A moderated mediation model was employed to examine the mediating role of perceived harm of e-cigarettes and the moderating effect of internalizing problems. RESULTS: Exposure to e-cigarette advertisements in Wave 3 predicted lower harm perception of e-cigarette in Wave 4 (bp = -0.055, p <.01), leading to more e-cigarette use in Wave 5 (bp = -0.042, p <.001). While e-cigarette advertisements exhibited a lasting indirect effect (bp = 0.002, p <.05), there was no long-term direct effect (bp = 0.017, p >.05) on youth e-cigarette use. Furthermore, a moderating effect of internalizing problems was observed (bp = 0.107, p <.05). CONCLUSIONS: E-cigarette advertisements can exert a lasting influence indirectly by diminishing harm perception, particularly among those with lower internalizing problems. Adolescents with higher internalizing problems exhibit lower susceptibility to advertisement influence, yet their perceived harm of e-cigarettes is notably lower than their peers with fewer internalizing problems. These disparities underscore the need for tailored prevention strategies: implementing anti-e-cigarette education programs for adolescents with low internalizing problems and providing mental health care for those facing internalizing challenges. Regulatory measures targeting e-cigarette advertising are also crucial.

Effects of Vape Use on Oral Health: A Review of the Literature.

Background and Objectives: The widespread use of tobacco has evolved with the popularity of vapes, especially among young people, despite the lack of clarity in warnings about their risks. Studies indicate the need for more effective communication about the oral risks of vaping. In addition to systemic, respiratory, and cardiovascular effects, vaping is associated with an increased risk of gingivitis and periodontal disease as well as reduced antioxidant capacity of saliva. The objectives of this narrative review are to summarize the existing information in the literature on the effects of vaping at the oral level and to bring together knowledge about the mechanism of action of vaping in oral tissues. Materials and Methods: In the present study, articles were searched in PubMed, Elsevier Scopus, and Web of Science using the keywords "oral health", "vaping", and "vape". Studies published in the last 6 years that addressed the effects of oral vaping were selected, including comparisons among vape users, smokers, and non-smokers. Repeated articles, prior to 2017 and in languages other than English, were excluded. Two review authors (A.M.I and M.F.E.M) independently selected the papers based on titles and abstracts and conducted a full review of the remaining papers. In cases of disagreement, a third reviewer was used. Results: A total of 113 results were obtained, distributed as 16 from PubMed, 35 from Web of Science, and 62 from Elsevier Scopus. After removing duplicates, 67 articles were filtered by reviewing titles and abstracts, and finally, 22 articles were selected for comprehensive reading. Subsequently, eight of these articles were chosen for qualitative synthesis and are presented in standardized tables. The sample size of all included studies was composed of 31,647 participants, (14,477 male and 17,170 female) with a mean of 35.016 ± 7.57 years of age. Conclusions: This review indicates that the use of vapes is associated with an increased risk of periodontitis and caries. Although users experience more oral problems than non-smokers, these are less severe than those of traditional smokers. The widespread prevalence, especially among young people, highlights the urgency of awareness campaigns to warn of risks and understand potential harm.

The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada.

BACKGROUND: Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days. METHODS: Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS: Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use. CONCLUSIONS: The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.

Eating Disorder Symptomatology Among Young Adult Cigarette and E-Cigarette Users.

Objective: Tobacco use is elevated among individuals with eating disorders (EDs). Yet, further research is needed to understand associations between cigarette and e-cigarette use patterns and ED symptomatology. To gain a more comprehensive understanding of tobacco use and EDs, this study characterized ED symptomatology and tobacco use patterns, including exclusive cigarette use, e-cigarette use, dual use, and nonuse. Method: Young adults aged 18-24 years who self-reported exclusive cigarette, e-cigarette, dual, or nonuse (N = 2500) were recruited via Lucid, an online survey management company. Participants completed questionnaires assessing body dissatisfaction, global ED psychopathology, binge eating and self-induced vomiting frequency, and demographics. ED diagnostic groups included: anorexia nervosa (AN), bulimia spectrum eating disorders (BSED), atypical AN, and night eating syndrome (NES). Results: Multinomial logistic models revealed those with AN were more likely to be dual users, those with atypical AN were more likely to be exclusive e-cigarette users, and participants with a BSED or NES were more likely to be exclusive e-cigarette or dual users, compared to those without an ED. General linear models suggested body dissatisfaction and global ED psychopathology were higher among exclusive e-cigarette and dual users, while binge eating and self-induced vomiting frequencies were greater among all tobacco use groups compared to nonusers. Discussion: Our findings suggest young adults with ED symptomatology were more likely to be users of e-cigarettes exclusively or dual users. It will be necessary to examine how these associations manifest using longitudinal and clinical populations in future research.

Correlates of using E-cigarettes with high nicotine concentrations among U.S. adults who exclusively vape E-cigarettes or dual use with cigarettes.

BACKGROUND: Identifying the correlates of using e-cigarettes with high nicotine concentrations in exclusive and dual-using vapers can elucidate which subpopulations might be most impacted by e-cigarette regulatory activities related to nicotine concentration. METHODS: Data are drawn from Wave 5 (December 2018-November 2019) of the Population Assessment of Tobacco and Health (PATH) study. Self-reported nicotine concentration was grouped as high (5.0 %+), moderate (1.8-4.9 %), low (0.1-1.7 %), 0 %, and "I don't know." Multivariable logistic regressions estimated associations of sociodemographic factors, tobacco use status, and e-cigarette use patterns of high nicotine concentration vs. other nicotine levels, stratified by current exclusive e-cigarette use and dual use of e-cigarettes and cigarettes. RESULTS: In the study samples (exclusive e-cigarette use [n = 1,755], dual-use [n = 1,200]), higher proportions of exclusive e-cigarette users reported using high nicotine concentrations than dual users (18.3 % vs. 8.6 %). Among exclusive e-cigarette users, never vs. former smokers and daily (vs. someday) e-cigarette users were more likely to use high vs. low nicotine. In both exclusive and dual users, younger (vs. older) adults were more likely to report using high nicotine concentration e-cigarettes than most other nicotine levels. Current dual users who did vs. did not report using e-cigarettes to quit smoking had higher odds of using high vs. 0 % nicotine concentrations. CONCLUSIONS: High-nicotine e-cigarette use might be elevated in subpopulations that face greater risks for vaping (e.g., never smokers, young adults) than groups who benefit from the potential harm reduction. Regulatory restrictions on high-nicotine products may selectively affect some subgroups adversely impacted by vaping.

Biomarker Assessment of Nicotine Exposure Among Adolescent E-Cigarette Users: 2018-2019.

BACKGROUND: Despite the increasing prevalence of vaping e-cigarettes among adolescents, there remains a lack of population-level assessments regarding the objective measurement of nicotine exposure. METHODS: This study analyzed a nationally representative sample of adolescents aged 13 to 17 years from Wave 5 of the Population Assessment of Tobacco and Health Study conducted between 2018 and 2019. Urinary nicotine metabolites, including cotinine and trans-3'-hydroxycotinine (3-HC), were assessed among exclusive nonnicotine e-cigarette users (n = 56), exclusive nicotine e-cigarette users (n = 200), and nonusers (n = 1059). We further examined nicotine exposure by past 30-day vaping frequency (ie, occasional [1-5 days], intermittent [6-19 days], and frequent [20+ days]) and flavor types among nicotine e-cigarette users. Multivariable linear regressions tested pairwise group effects, and biomarkers were normalized by the log transformation. RESULTS: Compared with nonusers, both nonnicotine and nicotine e-cigarette users exhibited higher levels of cotinine and 3-HC. Nicotine e-cigarette users had mean cotinine concentrations (61.3; 95% confidence interval, 23.8-158.0, ng/mg creatinine) approximately 146 times higher (P < .0001) than nonusers (0.4; 0.3-0.5), whereas nonnicotine users (4.9; 1.0-23.2) exhibited cotinine concentrations ∼12 times higher (P = .02). Among nicotine e-cigarette users, the levels of cotinine and 3-HC increased by vaping frequency, with cotinine increasing from 10.1 (2.5-40.1) among occasional users to 73.6 (31.8-170.6) among intermittent users and 949.1 (482.5-1866.9) among frequent users. Nicotine exposure was not significantly different by flavor type. CONCLUSIONS: E-cigarette use poses health-related risks resulting from nicotine exposure among adolescents. Comprehensive regulations of e-cigarette products and marketing, vaping prevention, cessation, and public policies are needed to prevent youth from developing nicotine addiction.

Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults.

BACKGROUND AND OBJECTIVES: Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. METHODS: Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). RESULTS: In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. CONCLUSIONS: Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs.

Patterns in Tobacco, E-Cigarette, and Cannabis Advertising Exposure Among California Adolescents and Associations With Future Use Expectations.

BACKGROUND: Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS: This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS: Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION: California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.

Susceptibility to e-cigarette use and associated factors in high school youth, Oklahoma Youth Tobacco Survey, 2021-2022.

Introduction: Susceptibility predicts subsequent uptake of e-cigarettes (EC) by youth. This study identified factors associated with EC susceptibility among high school students who have never used a tobacco/nicotine product. Methods: The Oklahoma Youth Tobacco Survey was administered to a random sample of 36 Oklahoma High Schools during the 2021-2022 school year (n = 1,220 participating students). Associations between EC susceptibility and covariates were identified using stepwise logistic regression for weighted survey data. Results: More than one third of Oklahoma high school students who had never used tobacco or nicotine products (36.4%) were susceptible, and males had higher susceptibility than females (38.8 and 33.9%, respectively). In males, EC susceptibility was associated with race (Black, American Indian, and other were less susceptible), psychological distress (aOR = 2.4, 95% CI = 1.1, 4.8), disagreement that all tobacco products are dangerous (aOR = 3.1, 95% CI = 1.2, 7.9), and perception of little/no harm from secondhand vapor (aOR = 3.4, 95% CI = 2.1, 5.3). In females, identifying as gay, lesbian, or bisexual (aOR = 2.1, 95% CI = 1.1, 3.9), poor academic performance (aOR = 4.5, 95% CI = 1.6, 12.6), psychological distress (aOR = 2.6, 95% CI = 1.2, 5.5) and interacting with EC content on social media (aOR = 5.9, 95% CI = 1.9, 18.1) were associated with EC susceptibility. Conclusion: Males and females had different patterns of susceptibility to EC use. Understanding groups of adolescents most susceptible to using nicotine products can help target prevention efforts at home, in schools, and within communities.

Impact of electronic cigarette use on the increased risk of diabetes: the Korean Community Health Survey.

OBJECTIVES: Only a few studies have solely investigated the health impacts of electronic cigarettes on diabetes while considering the impact of conventional cigarettes. Therefore, this study aimed to examine the effect of electronic cigarette smoking on diabetes in Korean dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. METHODS: Data were obtained from the 2021 and 2022 Korean Community Health Surveys of 460,603 Korean adults. The main independent variable was smoking behavior. Participants were categorized according to their smoking behavior, as dual smokers, electronic cigarette smokers, conventional cigarette smokers, and non-smokers. The dependent variable, the presence of diabetes, was defined by a doctor's diagnosis. Multiple logistic regression analysis was performed to examine the association between smoking behavior and diabetes. Subgroup analyses were also performed to investigate the associations among different socioeconomic groups. RESULTS: Conventional cigarette smokers had a higher risk of diabetes than did non-smokers (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.19 to 1.26). More importantly, those who only vaped electronic cigarettes were at high risk of diabetes (aOR, 1.15; 95% CI, 1.01 to 1.31). Lastly, dual smokers had the highest aOR for diabetes among other smoking behavior groups (aOR, 1.39; 95% CI, 1.22 to 1.58). Dual smoking was associated with the highest risk of diabetes in most subgroups. CONCLUSIONS: This study suggests that conventional cigarette use and smoking electronic cigarettes negatively impact diabetes, and using both types leads to worse health outcomes. Therefore, cessation of all types of smoking is necessary for a healthy life.

The association between excise taxes and smoking and vaping transitions-Findings from the 2016-2020 ITC United States surveys.

BACKGROUND: While a growing number of studies examined the effect of e-cigarette (EC) excise taxes on tobacco use behaviors using cross-sectional surveys or sales data, there are currently no studies that evaluate the impact of EC taxes on smoking and vaping transitions. METHODS: Using data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping Survey (ITC 4CV), we employed a multinomial logit model with two-way fixed effects to simultaneously estimate the impacts of cigarette/EC taxes on the change in smoking and vaping frequencies. RESULTS: Our benchmark model suggests that a 10 % increase in cigarette taxes led to an 11 % reduction in smoking frequencies (p < 0.01), while EC taxes did not have a significant effect on smoking frequencies. CONCLUSION: Our findings suggest that increasing cigarette taxes may serve as an effective means of encouraging people who smoke to cut back on smoking or quit smoking. The impact of increasing EC taxes on smoking transitions is less certain at this time.

Nicotine use among reservation-area American Indian adolescents compared with a national sample.

BACKGROUND: Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021-2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. METHODS: Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021-2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. RESULTS: Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. CONCLUSIONS: Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population.