Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes.

Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.

LGBT Identity and Its Influence on Perceived Effectiveness of Advertisements from a LGBT Tobacco Public Education Campaign.

Lesbian, gay, bisexual, and transgender (LGBT) individuals are at increased risk for tobacco use compared to those who are not LGBT. The Food and Drug Administration's Center for Tobacco Products launched the first U.S. large-scale tobacco public education campaign for LGBT young adults aged 18-24, This Free Life. The current study, using data from the evaluation of the This Free Life campaign, investigated the role of LGBT Identity Affirmation (i.e., the development of positive feelings or attachment to being LGBT), LGBT Identity Centrality (i.e., the degree to which an aspect of a person's identity shapes their overall identity), and Identification with the LGBT Community (i.e., an individual's relationship with the LGBT community) on perceived effectiveness of four This Free Life advertisements. The current study sample included 2,788 LGBT young adults. For the "Our Story" and "Flawless" advertisements, all three identity constructs were statistically significant positive predictors of perceived advertisement effectiveness. For female-centric and male-centric "Tip the Scale" advertisements, LGBT Identity Centrality and Identification with the LGBT Community were significant positive predictors. An additional secondary analysis found differences in identity constructs between sexual and gender minority subgroups. These results support that identity constructs may be leveraged in health interventions.

The Potential (F)utility of a Passive Organ Donor Registration Opportunity: A Conceptual Replication.

CONTEXT: Approximately 22 people die each day in the United States as a result of the shortage of transplantable organs. This is particularly problematic among Spanish-dominant Hispanics. Increasing the number of registered organ donors can reduce this deficit. OBJECTIVE: The goal of the current set of studies was to conceptually replicate a prior study indicating the lack of utility of a lone, immediate and complete registration opportunity (ICRO). DESIGN AND SETTING: The study, a quasi-experimental design involving a total of 4 waves of data collection, was conducted in 2 different Mexican consulates in the United States. Guided by the IIFF Model (ie, an ICRO, information, focused engagement, and favorable activation), each wave compared a lone ICRO to a condition that likewise included an ICRO but also included the 3 additional intervention components recommended by the model (ie, information, focused engagement, and favorable activation). PARTICIPANTS: Visitors to the Mexican consulates in Tucson, Arizona, and Albuquerque, New Mexico, constituted the participant pool. MAIN OUTCOME MEASURE: New organ donor registrations represented the dependent variable. RESULTS: When all 4 components of the IIFF Model were present, approximately 4 registrations per day were recorded; the lone ICRO resulted in approximately 1 registration every 15 days. CONCLUSION: An ICRO, without the other components of the IIFF Model, is of minimal use in regard to garnering organ donor registrations. Future studies should use the IIFF Model to consider how the utility of ICROs can be maximized.

An Investigation of Age-Differentiated Conversations About Electronic Nicotine Delivery Systems on Reddit.

Introduction: This study analyzes age-differentiated Reddit conversations about ENDS. Methods: This study combines 2 methods to (1) predict Reddit users' age into 2 categories (13-20 years [underage] and 21-54 years [of legal age]) using a machine learning algorithm and (2) qualitatively code ENDS-related Reddit posts within the 2 groups. The 25 posts with the highest karma score (number of upvotes minus number of downvotes) for each keyword search (i.e., query) and each predicted age group were qualitatively coded. Results: Of 9, the top 3 topics that emerged were flavor restriction policies, Tobacco 21 policies, and use. Opposition to flavor restriction policies was a prominent subcategory for both groups but was more common in the 21-54 group. The 13-20 group was more likely to discuss opposition to minimum age laws as well as access to flavored ENDS products. The 21-54 group commonly mentioned general vaping use behavior. Conclusions: Users predicted to be in the underage group posted about different ENDS-related topics on Reddit than users predicted to be in the of-legal-age group.

U.S. digital tobacco marketing and youth: A narrative review.

We describe findings from peer-reviewed articles on digital tobacco marketing (DTM) using U.S. data related to youth, including research that examines use of age restrictions, DTM exposure and engagement, and associated tobacco use. We searched PubMed, EMBASE, Web of Science, and EBSCOhost in May 2019 and May 2020 for published English language peer-reviewed articles examining DTM that were published from January 2016 to May 2020. Inclusion coding occurred in three stages. The first search identified 519 articles; 167 were coded for inclusion. The second search identified 189 articles; 67 were coded for inclusion. Two coders then assessed whether the included articles mentioned youth (age 18 and younger) or age restrictions in the method and results sections of the full text. Ultimately, 47 articles were included in this review. A codebook was developed and tested through training. Each article was coded for age restrictions, youth exposure to DTM, youth engagement with DTM, and youth tobacco use associated with DTM exposure or engagement. The studies reviewed indicate that DTM on social media was infrequently age-restricted and the stringency of age restriction varied by tobacco product, site owner, and channel. Youth reported being exposed to DTM frequently via the Internet. While youth reported less frequently engaging with DTM compared to being exposed, engagement increased over time. DTM exposure and engagement were associated with tobacco product use. The studies reviewed document an association between DTM exposure and engagement and future tobacco use; thus, DTM may be contributing to the youth tobacco epidemic.

Unpacking Cigar Product Familiarity and Terminology among Black and Hispanic Youth: It's All about Blunts.

The prevalence rate of Cigar, Little Cigar, and Cigarillo (CLCC) use among youth rose above the rate of cigarettes for the first time in 2019, and Black and Hispanic youth remain disproportionately more susceptible and likely to use these products compared to White youth. Addressing this disparity through education requires a clearer understanding of the ways youth refer to, and group, CLCCs. Twenty-eight virtual focus groups with youth ages 13-17 (n = 105) were conducted across the U.S. Groups were split by race/ethnicity, with 14 Black and 14 Hispanic groups, and further divided by CLCC experimenters and susceptible users. Youth participants discussed CLCC use behaviors, harm and risk perceptions, and knowledge, attitudes, and beliefs about CLCC products. When shown photos of CLCC products during focus groups, youth across groups identified and labeled these products into four subcategories. Large cigars were universally labeled "cigars". Little cigars were unfamiliar and guessed to be cigarettes. Tipped cigarillos were synonymous with the brand Black and Mild and considered tobacco. Untipped cigarillos were most referred to as "blunts" and used with marijuana. Understanding the nuances of language and use patterns of CLCCs is critical to ensuring the accuracy of measurement and impact of public health communications.

Those who believe they can, do: The relationship between smoking avoidance beliefs, perceived risks of smoking, and behavior in a sexual and gender minority young adult sample.

An individual's beliefs in their perceived risk and ability to resist smoking have been found to be associated with smoking behavior. The current study explores the effects of confidence in one's ability to avoid smoking, measured by avoidance beliefs, on the relationship between perceived risks of smoking and behavior. This analysis was done using 2016 baseline data collected among 4057 participants aged 18-24 for the evaluation of a large-scale public education campaign in the U.S. aimed at reducing tobacco use among sexual and gender minority young adults. The analytic sample included roughly 3493 participants per analysis. Analyses used the following measures: (1) perceived risks of smoking (e.g., smoking cigarettes will shorten my life); (2) confidence to avoid smoking in various situations (i.e., avoidance beliefs), and (3) past 30-day cigarette smoking. Binary logistic regression models with interaction analyses assessed the relationship between perceived risks of smoking and past 30-day smoking behavior using the interaction term of avoidance beliefs. An interaction between perceived risks of smoking and avoidance behaviors interaction emerged, such that the negative relationship between perceived risks of smoking and smoking behavior was stronger for those who believed that they could avoid smoking in various situations. This suggests that the relationship between perceived risk and smoking behavior can be bolstered if one's beliefs about their ability to avoid smoking are strong. Campaigns that build smoking avoidance confidence may enhance the effects of tobacco outcome expectations-related messaging on smoking.

Youth peer crowds and risk of cigarette use: The effects of dual peer crowd identification among hip hop youth.

INTRODUCTION: Recent research has found that the Hip Hop peer crowd has a strong link to risky health behaviors, including tobacco use. The current study expands on previous research on the Hip Hop peer crowd by investigating the nuances of the effects on cigarette risk that Hip Hop identification has in combination with other peer crowds. METHODS: Targeted social media advertisements were used to recruit youth to complete an online survey. Participants (n = 4681) self-reported peer crowd identification via the I-Base Survey™, and cigarette smoking status. Smoking status was compared between peer crowd groups consisting of participants who had identification with only one peer crowd, and those who had identification with the Hip Hop peer crowd and one other crowd (i.e., Hip Hop dual peer crowd identification). RESULTS: Significant differences in cigarette status were observed among the dual and single peer crowd groups. Specifically, differences in cigarette Non-susceptible Non-triers and Experimenters demonstrated that youth who identified as Mainstream Only were at lowest risk while youth who identified as Hip Hop/Alternative had the highest rates of cigarette experimentation. There were no differences between peer crowd groups on proportions of Susceptible Non-triers. CONCLUSIONS: Examining dual peer crowd identifications provides a nuanced understanding of risk. Dual identification with Hip Hop seems to have differential effects compared to solo identification with other crowds, whereby Hip Hop identification may increase cigarette experimentation when combined with another peer crowd. Findings demonstrate the potential of considering multiple peer crowd identification to inform public education campaign development.

The Hip Hop peer crowd: An opportunity for intervention to reduce tobacco use among at-risk youth.

INTRODUCTION: Peer crowds, peer groups with macro-level connections and shared norms that transcend geography and race/ethnicity, have been linked to risky health behaviors. Research has demonstrated that Hip Hop peer crowd identification, which is common among multicultural youth, is associated with increased risk of tobacco use. To address this, the FDA Center for Tobacco Products created Fresh Empire, the first national tobacco education campaign tailored for Hip Hop youth aged 12-17 who are multicultural (Hispanic, African American, Asian-Pacific Islander, or Multiracial). As part of campaign development, peer crowd (Hip Hop, Mainstream, Popular, Alternative, Country) and cigarette smoking status were examined for the first time with a nationally recruited sample. METHODS: Youth were recruited via targeted social media advertisements. Participants aged 13-17 (n = 5153) self-reported peer crowd identification via the I-Base Survey™ and cigarette smoking status. Differences in smoking status by peer crowd were examined using chi-square and followed up with z-tests to identify specific differences. RESULTS: Alternative youth were most at risk of cigarette smoking, followed by Hip Hop. Specifically, Hip Hop youth were significantly less likely to be Non-susceptible Non-triers than Popular, Mainstream, and Country youth, and more likely to be Experimenters than Popular and Mainstream youth. CONCLUSIONS: Representative studies show that Alternative is relatively small compared to other high-risk crowds, such as the Hip Hop peer crowd. The current research underscores the potential utility of interventions tailored to larger at-risk crowds for campaigns like Fresh Empire.

Anger, frustration, boredom and the Department of Motor Vehicles: Can negative emotions impede organ donor registration?

RATIONALE: The IIFF Model (Information, Immediate and Complete Registration Mechanism, Focused Engagement, Favorable Activation) offers a checklist of considerations for interventions seeking to influence organ donor registration behavior. One aspect of the model, favorable activation, recommends considering the emotional and motivational state of a potential donor registrant. Given that most donor registrations occur at the Department of Motor Vehicles (DMV), we considered whether emotions experienced while at the DMV could influence registration rates. OBJECTIVE: The current research effort investigated the emotions people experience while visiting the DMV, explored whether these emotions are associated with donor registration intentions, and experimentally assessed whether DMV experiences influence donor registration. METHODS: Three studies were conducted through Amazon's Mechanical Turk. In Study 1, we randomly assigned participants to either recall a prior DMV experience or to a comparison condition. Emotions associated with the recalled experiences were the dependent variable. Study 2 assessed the correlations between nine different emotions and donor registration intentions. Study 3 randomly assigned participants to recall a prior frustrating DMV experience or to a comparison condition. Intention to register to donate was the dependent variable. RESULTS: Study 1 found that recalling a prior DMV experience was associated with more negative and less positive emotions than the comparison condition. Study 2 found that increased levels of negative emotion could be problematic, as negative emotions were associated with decreased donor intentions. Study 3 found that recalling a frustrating DMV experience resulted in significantly lower intentions to register as an organ donor (vs. a control condition). CONCLUSION: Although not all DMV experiences are negative, these data indicated a relationship between the DMV and negative emotions; an association between negative emotions and lower donor registration intentions; and, a causal relationship between negative DMV experiences and decreased registration intentions.

The impact of overtly listing eligibility requirements on MTurk: An investigation involving organ donation, recruitment scripts, and feelings of elevation.

RATIONALE: Investigations conducted through Amazon's Mechanical Turk (MTurk) sometimes explicitly note eligibility requirements when recruiting participants; however, the impact of this practice on data integrity is relatively unexplored within the MTurk context. OBJECTIVE: Contextualized in the organ donor registration domain, the current study assessed whether overtly listing eligibility requirements impairs the accuracy of data collected on MTurk. METHODS: On day 1, the first and third round of data collection did not list eligibility requirements; the second and fourth round overtly listed a qualification requirement: status as a non-registered organ donor. On day 2, the approach was identical, except the order was reversed-the first and third round overtly listed the study qualifications, while the second and fourth did not. These procedures provided eight different waves of data. In addition, all participants were randomly assigned to read an elevating (i.e., morally inspiring) story or a story not intended to elicit any emotion. Regardless of recruitment approach, only participants who were not registered as donors were included in the analysis. RESULTS: Results indicated that the recruitment script that explicitly requested non-registered donors resulted in the collection of participants with higher mean intentions scores than the script that did not overtly list the eligibility requirements. Further, even though the elevation induction increased intentions to register as a donor, there was not a significant interaction between recruitment approach and the influence of the elevation manipulation on registration intentions. CONCLUSION: Explicitly listing eligibility requirements can influence the accuracy of estimates derived from data collected through MTurk.

The power of the proposition: frequency of marijuana offers, parental knowledge, and adolescent marijuana use.

BACKGROUND: The frequency with which adolescents are offered marijuana has been investigated as a predictor of marijuana use. The current study was designed to test whether the number of marijuana offers received provides an indirect path between parental knowledge and adolescents' marijuana use. METHODS: Data from the nationally representative National Survey of Parents and Youth were examined. Analysis 1 tested the association between frequency of being offered marijuana and adolescents' (N=4264) marijuana usage in the subsequent year. Analysis 2, spanning a three-year time frame, tested whether the frequency of marijuana offers at the second year of the panel study bridged the relationship between parental knowledge in Year 1 and marijuana use in Year 3. RESULTS: Analysis 1 indicated that the frequency with which adolescents were offered marijuana predicted usage one year later, after controlling for previous usage and nine other common predictors of marijuana use. Analysis 2 revealed an indirect relationship between parental knowledge and use through the number of marijuana offers the adolescent received. CONCLUSION: There was a strong link between the number of offers received and adolescents' future marijuana use. Higher parental knowledge predicted reductions in offer frequency, which was associated with lower levels of marijuana use. Reducing the number of marijuana offers an adolescent receives could serve as a useful focus for intervention programs targeting parents.

Attitude-behavior consistency, the principle of compatibility, and organ donation: A classic innovation.

OBJECTIVE: The lack of consistency between peoples' attitudes toward organ donation and organ donation registration behavior has long perplexed scholars. Ajzen and Fishbein's principle of compatibility offers a potential explanation for the attitude-behavior discrepancy. This principle states that attitudes will better predict behavior if the specificity of a measured attitude matches the specificity of the behavior under consideration. METHOD: Two studies, using different samples and different modes of data collection, measured general attitudes toward organ donation and specific attitudes toward registering as a donor, while simultaneously offering a registration opportunity. RESULTS: Compared with general attitudes about organ donation, attitudes specific to organ donor registration were superior predictors of registration intentions and behaviors. Specific attitudes explained at least 70% more variance in registration behaviors than general attitudes. CONCLUSION: The lack of attitude-behavior consistency in the organ donor domain can be partially explained by limited compliance with the principle of compatibility.