Gendered Conceptions of Preconception Health: A Thematic Analysis of Men's and Women's Beliefs about Responsibility for Preconception Health Behavior.

Preconception health (PCH) focuses on taking steps before a pregnancy to safeguard the health of the woman and future baby. Although recommendations to improve PCH target all people of reproductive age, research shows most interventions and messages focus primarily on women, which may contribute to existing normative beliefs that women are more responsible for protecting children's health. In this study, we explore society's gendered expectations of responsibility for engaging in recommended PCH behaviors (i.e., avoiding smoking, drinking, and environmental toxins). An applied thematic analysis of online survey responses from U.S. men and women (N = 573) identified five main themes and related subthemes: body and health, shared responsibility, choice and moral obligation, gender stereotypes, and doubt and uncertainty. Both men and women frequently referenced biological connections between prospective parents and offspring as justification for PCH behaviors. When challenging PCH recommendations, respondents mentioned excessive control of women and men's secondary role in reproduction. Overall, gender stereotypes were more commonly expressed in relation to men yet reflected both traditional and contemporary male roles (i.e., as supporters, co-parents). When judging personal responsibility, women commonly viewed PCH behaviors as the 'duty of a good mother'. Implications for PCH communication research and practice are discussed.

Prevalence and correlates of past 30-day dual-vaping of nicotine and cannabis among adolescents in five New England states.

SIGNIFICANCE: Adolescent vaping behavior includes vaping of multiple substances, including both nicotine and cannabis (dual-vaping). This study describes the prevalence and the sociodemographic correlates of past 30-day dual-vaping. METHODS: We recruited adolescents ages 13-17 from five New England states (Massachusetts, Connecticut, Rhode Island, Vermont, New Hampshire) through the Prodege online survey panel from April 2021 to August 2022. Dual-vaping was defined as vaping both nicotine and cannabis (THC and/or CBD) in the past 30-days. We analyzed the prevalence of sole-nicotine, sole-cannabis, and dual-vaping of nicotine and cannabis and used multinomial logistic regression to examine associations between sociodemographic factors and sole- and dual-vaping of nicotine and cannabis. RESULTS: The analytic sample included 2013 observations from 1858 participants (mean age 15.1 years, 46.2% female, 74.1% White, 82.2% heterosexual). Among these observations, 5.6% reported past 30-day sole-nicotine vaping, 5.5% reported sole-cannabis vaping, and 7.3% had dual-vaped. Correlates for higher odds of past 30-day dual-vaping included total social media sites used and household tobacco use, in contrast with sole-cannabis vaping, which included older age and self-reported depression (all p's <0.05). DISCUSSION: Adolescent past 30-day dual-vaping of nicotine and cannabis was more prevalent than past 30-day sole-vaping of either nicotine or cannabis alone. Future studies should continue to collect detailed data on the type of substances, besides nicotine, that adolescents are vaping.

Education, organizational changes, and enforcement challenges of the 2019 flavored tobacco sales restriction in Massachusetts.

OBJECTIVES: In November 2019, the Massachusetts legislature passed An Act Modernizing Tobacco Control and became the first state to restrict retail sales of all flavored (including menthol) cigarettes, e-cigarettes, and other tobacco products (the Act). Additional tobacco control policies and health insurance coverage for tobacco treatment were included as part of the Act. Implementation of these policies occurred between November 2019 and June 2020. This study explored challenges and facilitators during the implementation of the Act experienced by public health officials, school personnel, and healthcare providers. METHODS: We conducted in-depth interviews with a purposive sample of 9 public health officials and advocates, 9 school personnel, and 8 healthcare providers from March to December 2021. We conducted thematic analysis of interview transcripts using inductive codes of key themes emerging from the interviews. RESULTS: Interviewees highlighted three key themes that impacted the implementation of the Act: 1) Education of those impacted by the Act, 2) Organizational-level changes to incorporate the Act, and 3) Enforcement challenges. Examples of challenges to the implementation of the Act included COVID-19 pandemic restrictions, navigating tobacco industry tactics around naming flavors, and confusion regarding health insurance coverage for tobacco use cessation programs. Examples of facilitators were enforcement leading to retailer compliance, committed advocacy efforts of leadership/champions, and strong coordination within and between organizations. CONCLUSIONS: These findings of Massachusetts's experience in policy implementation can inform the preparation to implement similar tobacco control policies in other states.

Effects of brief exposure to misinformation about e-cigarette harms on Twitter on knowledge and perceptions of e-cigarettes.

Background: This study examined whether exposure to misinformation found on Twitter about e-cigarette harms leads to inaccurate knowledge and misperceptions of harms of e-cigarette use among cigarette smokers. Methods: We conducted an online randomized controlled experiment in November 2019 among an online sample of 2400 adult US and UK cigarette smokers who did not currently use e-cigarettes. Participants viewed four tweets in one of four conditions: 1) e-cigarettes are as or more harmful than smoking, 2) e-cigarettes are completely harmless, 3) e-cigarette harms are uncertain and 4) control (physical activity). Outcomes were knowledge about e-cigarettes and harm perceptions of e-cigarette use for five diseases. We conducted multiple logistic and linear regressions to analyze the effect of experimental conditions on outcomes, controlling for baseline knowledge and perceived harms. Findings: Participants in the 'as or more harmful' condition (vs. control group) had higher odds of accurate knowledge about e-cigarettes containing toxic chemicals (p < 0.001), not containing only water vapor (p < 0.001) and containing formaldehyde (p < 0.001). However, these participants had lower odds of accurate knowledge that e-cigarettes did not contain tar (p < 0.001) and contained fewer toxins than cigarettes (p < 0.001). Exposure to 'as or more harmful' tweets also increased harm perceptions for five diseases (all p < 0.001), with the greatest effect observed for lung cancer (ß = 0.313, p < 0.001). This effect was greater among UK participants for all diseases. Interpretation: Brief exposure to misinformation on Twitter reduced accurate knowledge of the presence of tar and the level of toxins compared with smoking and increased harm perceptions of e-cigarette use.

Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice.

BACKGROUND: Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. OBJECTIVE: This study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. METHODS: We conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants' photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. RESULTS: We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. CONCLUSIONS: The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals.

Sources of Awareness of JUUL E-cigarettes in 2 Surveys of Adults in the United States.

Objectives: Since their introduction in 2015, JUUL e-cigarettes have gained >60% of the United States (US) 2018 retail market share among branded e-cigarette companies. The sources through which consumers learn about JUUL e-cigarettes is not known. Methods: We assessed the sources of awareness about JUUL through 2 cross-sectional surveys of US adults (Survey 1: 502 18-24 year-olds; Survey 2: 803 smokers age 18+). Primary measures were awareness of JUUL and sources through which participants learned about JUUL. Results: Awareness of JUUL was greater among smokers and younger adults (age <30). Common sources of awareness were advertisements, news, and word-of-mouth. Conclusions: This study is the first to identify sources through which never, non-current ever, and current smokers learned about JUUL e-cigarettes. Regulatory efforts and educational interventions may opt to focus on these channels.

The Use of Substances Other Than Nicotine in Electronic Cigarettes Among College Students.

INTRODUCTION: Electronic cigarettes (e-cigarettes) have grown in popularity, especially among youth and young adults. Although e-cigarettes were originally intended to vaporize a liquid mixture containing nicotine, there appears to be an increasing trend in other substance use in e-cigarettes (OSUE). MATERIALS AND METHODS: Cross-sectional data from 1542 undergraduate college student e-cigarette users from a large Midwestern university were collected via online survey to assess prevalence of e-cigarette use, reasons for use, perceived harm, and prevalence and predictors of OSUE. RESULTS: Nearly 7% (6.94%) reported using an e-cigarette to vaporize and inhale a substance other than nicotine. Current tobacco cigarette smokers were significantly more likely to report OSUE (51.0%) as compared with never (33.7%) and former (15.4%) smokers. Among respondents reporting OSUE, the primary reason for e-cigarette use was "safer than cigarettes" (21.7%), followed by "experimentation" (18.9%) and "friends use" (17.0%). Most (77.9%) reported using cannabis or some derivative of cannabis in an e-cigarette. Binomial logistic regression found that women were less likely to report OSUE by a factor of 0.60, former tobacco cigarette smokers as compared with never smokers were more likely to report OSUE by a factor of 1.87, and e-cigarette users who reported using e-cigarettes for "cool or trendy" reasons were more likely to report OSUE by a factor of 2.89. DISCUSSION: Little is known regarding the health effects of cannabis and cannabis derivatives delivered through e-cigarettes. Concern may also be warranted regarding the potential dangers of this young population using substances more dangerous than cannabis in e-cigarettes. Knowledge is limited regarding the public health impact of vaping cannabis or other illicit substances among college student populations. This study stresses the need for continued research regarding the vaping of cannabis and other illicit substances among college students.

Measuring Exposure to Direct-to-Consumer Advertising-A Validation Study in the Context of Cancer-Related Treatment Advertising.

This research examines two recurrent conceptual issues of measuring media exposure in survey research in the context of cancer-related direct-to-consumer advertising (CR-DTCA)-the level of content specificity of survey items and the benefits of providing exemplars to aid recall. We evaluated three candidate measures of cancer patients' self-reported exposure to CR-DTCA; these measures varied in content specificity and provision of ad exemplars. Using data from two distinct population-based surveys, we assessed the performance of each measure based on several reliability and validity criteria. Results across both surveys indicate that all three measures performed equally well in terms of internal consistency, convergent, nomological, and discriminant validity with a few minor differences between these measures. Increased content specificity or inclusion of ad exemplars did not result in better performance of the exposure measures. Participants were able to extrapolate from ad exemplars to report their exposure to broad categories of CR-DTCA. The briefest of the three measures posed the lowest level of survey costs among the three measures and was deployed successfully for both mailed and internet-based survey administration. We discussed future directions for application of these findings in DTCA research for other illness and for media exposure research more generally.