Should Communication Campaigns Promoting Vaccination Address Misinformation Beliefs? Implications from a Nationally Representative Longitudinal Survey Study among U.S. Adults.

Public health communication campaign planners must carefully consider whether misinformation beliefs are important to target and, ideally, correct. Guided by the reasoned action approach, we hypothesized that behavior-specific beliefs regarding COVID-19 vaccination would account for any observed relationship between general coronavirus misinformation beliefs (misinformation beliefs that are not specific to the anticipated consequences of COVID-19 vaccination) and subsequent vaccine uptake. To test our hypothesis, we used panel data from a two-wave nationally representative sample of U.S. adults pre- and post-vaccine availability (T1: July 2020, T2: April/June 2021, analytic sample: n = 665). Contrary to our hypothesis, we find a residual observed relationship between general coronavirus misinformation beliefs and subsequent vaccine uptake (AOR = 0.40, SE = 0.10). Intriguingly, our post-hoc analyses do show that after also adjusting for T2 behavioral beliefs, this association was no longer significant. With this and other justifications, we recommend that messages promoting vaccination prioritize targeting relevant behavioral beliefs.

Modification Mechanisms of Descriptive Norm Perceptions Toward Vaping: The Role of Behavior Prevalence and Group Size in an Online Setting.

We often rely on descriptive norm perceptions as a mental shortcut for decision making. However, less is known about how such perceptions are shaped and modified by our experiences in day-to-day life. The interactive nature of the current media environment offers opportunities for individuals to access others' health behavior choices through online user-generated content. Within a setting of online comment boards, the current study examined the descriptive norm perception modification process toward vaping with a large-scale experiment that systematically varied levels of exposure to online commenters' vaping behavior choice indications. Findings revealed a significant positive effect of behavior prevalence on descriptive norm perceptions, which in turn were positively associated with vaping intention. This set of results was observed only when a sufficient total amount of comment exposures was ensured. The study provided empirical evidence for the underlying mechanism of the "quasi-statistical sense," which helps people draw conclusions about behavior prevalence and may influence their behavioral decision making. Theoretical and practical implications are discussed.

Not all norm information is the same: Effects of normative content in the media on young people's perceptions of e-cigarette and tobacco use norms.

Norm information in media can predict individuals' norm perceptions and, ultimately, their behavior. Little research has examined how descriptive norm information manifests in media and impacts beliefs in the real world. Previously, using automated content analysis, we measured and examined longitudinal trends in two types of descriptive norm information, individual use depictions and population norms, pertaining to tobacco and e-cigarette use across six media sources from 2014-2017. Here, we assess how this norm information affected norm perceptions over time by pairing these data with a rolling cross-sectional survey of young people's beliefs and intentions related to these behaviors. We found that individual use depictions predicted some norm perceptions, although the direction of effects varied depending on the source, behavior, and type of perceptions considered. Population norm content did not affect perceptions. These findings highlight that real-world media norm information has real-world effects, and moderators of these effects should be studied.

Comparing belief in short-term versus long-term consequences of smoking and vaping as predictors of non-use in a 3-year nationally representative survey study of US youth.

INTRODUCTION: Efforts to prevent youth tobacco use are critical to reducing smoking-related deaths in the USA. Anti-tobacco messaging often focuses on the severe long-term consequences of smoking (eg, fatal lung disease, cancer). It is unclear whether these long-term consequences are more likely to deter youth use than shorter term consequences (eg, headaches, friend disapproval). METHODS: A nationally representative 3-year rolling survey of adolescents and young adults (ages 13-26 years) measured belief in potential consequences of two types of tobacco products: combustible cigarettes (n=11 847) and electronic cigarettes (n=4470) as well as intentions and current use. Independent coders classified 23 consequences as either short or long term. Logistic regression tested the associations between short-term (vs long-term) beliefs and current intentions, as well as non-smoking behaviour at 6-month follow-up. RESULTS: Believing in both short-term and long-term consequences was associated with outcomes, but short-term beliefs were more highly associated with anti-smoking (OR=1.40, 95% CI (1.30 to 1.51)) and anti-vaping (OR=2.10, 95% CI (1.75 to 2.52)) intentions and better predicted non-smoking behaviour at follow-up, controlling for prior use (OR=1.75, 95% CI (1.33 to 2.31)). CONCLUSIONS: These results support temporal discounting by adolescents and young adults and suggest health communication efforts aiming to reduce youth tobacco use should emphasise shorter term consequences.

Rating the Valence of Media Content about Electronic Cigarettes Using Crowdsourcing: Testing Rater Instructions and Estimating the Optimal Number of Raters.

Electronic cigarettes (e-cigarettes) are a controversial public health topic due to their increasing popularity among youth and the uncertainty about their risks and benefits. Researchers have started to assess the valence of media content about e-cigarette use, mostly using expert coding. The current study aims to offer a methodological framework and guideline when using crowdsourcing to rate the valence of e-cigarette media content. Specifically, we present (1) an experiment to determine rating instructions that would result in reliable valence ratings and (2) an analysis to identify the optimal number of raters needed to replicate these ratings. Specifically, we compared ratings produced by crowdsourced raters instructed to rate from several different perspectives (e.g., objective vs. subjective) and determined the instructions that led to reliable ratings. We then used bootstrapping methods and a set of criteria to identify the minimum number of raters needed to replicate these ratings. Results suggested that when rating e-cigarette valence, instructing raters to rate from their own subjective perspective produced reliable results, and nine raters were deemed the optimal number of raters. We expect these findings to inform future content analyses of e-cigarette valence. The study procedures can be applied to crowdsourced content analyses of other health-related media content to determine appropriate rating instructions and the number of raters.

Association of COVID-19 Misinformation with Face Mask Wearing and Social Distancing in a Nationally Representative US Sample.

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n = 1074) and 7/15/20-7/21//20 (n = 889; follow-up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B = -.27, SE =.06) and social-distancing behaviors (B = -.46, SE =.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B =.43, SE =.05; B =.63, SE =.09) and lagged over time (B =.20, SE = 04; B =.30, SE =.08). In conclusion, belief in COVID-19-related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims.

Valence of Media Coverage About Electronic Cigarettes and Other Tobacco Products From 2014 to 2017: Evidence From Automated Content Analysis.

INTRODUCTION: As media exposure can influence people's opinions and perceptions about vaping and smoking, analyzing the valence of media content about tobacco products (ie, overall attitude toward tobacco, cigars, electronic cigarettes, etc.) is an important issue. This study advances the field by analyzing a large amount of media content about multiple tobacco products across six different media sources. AIMS AND METHODS: From May 2014 to December 2017, we collected all English-language media items about tobacco products that U.S. young people might see from mass media and websites (long-form) and social media (Twitter and YouTube). We used supervised machine learning to develop validated algorithms to label the valence of these media items. Using the labeled results, we examined the impact of product type (e-cigarettes vs. other tobacco products), source (long-form vs. social media), and time (by month) on the valence of coverage. RESULTS: We obtained 152 886 long-form media texts (20% with more than a passing mention), nearly 86 million tweets, and 12 262 YouTube videos about tobacco products. Most long-form media content opposed, while most social media coverage supported, the use of e-cigarettes and other tobacco products. Over time, within-source valence proportions were stable, though in aggregate, the amount of media coverage against the use of tobacco products decreased. CONCLUSIONS: This study describes the U.S. public communication environment about vaping and smoking for young people and offers a novel big data approach to analyzing media content. Results suggest that content has gradually become less negative toward the use of e-cigarettes and other tobacco products. IMPLICATIONS: This study is the first to examine how the valence of media coverage differs for e-cigarettes versus other tobacco products, across several media sources, and over time using a large corpus of media items. Unlike prior studies, these data allow us to draw conclusions about relative support and opposition for these two categories of products in a variety of media coverage because the same coding scheme was used across products and media sources.

An Investigation of Low COVID-19 Vaccination Intentions among Black Americans: The Role of Behavioral Beliefs and Trust in COVID-19 Information Sources.

Developing a COVID-19 vaccine is a critical strategy for combatting the pandemic. However, for vaccination efforts to succeed, there must be widespread willingness to vaccinate. Prior research has found that Black Americans, who are disproportionately impacted by COVID-19, report lower intentions to get a vaccine than do other populations. We investigate two potential contributors to this disparity: COVID-19 vaccine-related behavioral beliefs and trust in four COVID-19 information sources (mainstream media, social media, President Trump, and public health officials and agencies). Using a nationally-representative survey (n= 889), we demonstrate that differences in vaccination beliefs explain the lower vaccination intentions reported by Black participants, compared to non-Black participants. However, while trust in information sources is associated with vaccination beliefs, differences in trust do not account for the observed differences in vaccination beliefs by race. Furthermore, we find that race moderates the relationships between trust in two sources (Trump and public health officials and agencies) and vaccination beliefs. The effects of trusting these sources on COVID-19 vaccine-related beliefs are smaller among Black participants; thus trust in these sources is less consequential to their pro-vaccination beliefs. Our results suggest that trust in information sources alone does not explain the observed relationship between race and vaccination beliefs.

A Toxic Blend: Assessing the Effects of Cross-Source Media Coverage of Flavored E-Cigarettes on Youth and Young Adult Perceptions.

Flavored e-cigarettes have received high attention across social and news media. How does exposure to e-cigarette flavors across multiple sources in the media environment influence youth e-cigarette perceptions? To address this question, we identified e-cigarette flavor mentions on 24.3 million Twitter posts and 11,691 longform texts (newspapers, broadcast news, and websites) disseminated over 3 years (2014-2017). During the same period, we measured e-cigarette beliefs through a nationally representative randomly sampled rolling survey of 13-26-year-olds (N = 4,470, 1013 days). We estimated the association between flavor-specific content on Twitter and longform sources in the 28 days prior to each survey date and perceptions that e-cigarettes taste good. The interaction of coverage on Twitter and longform sources was significantly associated with more favorable perceptions of e-cigarette taste (OR = 1.21; 95% CI, 1.04-1.41); the main effects of each source type were not significant. This study presents a novel approach to evaluating the effects of cross-source coverage in today's complex media landscape and may strengthen claims for media influence on e-cigarette use.

Exploring the Effect of Health App Use on Fruit and Vegetable Consumption.

People may use multiple health apps at the same time or in close sequence, and the effect of health apps may vary across different socioeconomic groups. However, in the context of healthy eating, studies have focused on the effect of using a single health app. This study aims to test the relationship of using multiple health apps with fruit and vegetable consumption, assessing moderation by education level. Employing longitudinal survey data from South Korean adults, we conducted regression analyses to test the lagged association between use of health apps and intake of fruits and vegetables, and whether education moderates the relationship. The results supported the positive lagged relationship of health app use with fruit and vegetable consumption, significant after controlling for confounders and baseline fruit and vegetable consumption. The association was smaller among respondents with higher education. Our findings suggest the positive effect of using multiple health apps on fruit and vegetable consumption, implying the importance of finding the best combination of health apps to maximize their effectiveness in promoting healthy eating. Also, the negative interaction of health app use and education support using mobile communication technology to improve the public health of low socioeconomic status individuals.

Breadth of Media Scanning Leads to Vaping among Youth and Young Adults: Evidence of Direct and Indirect Pathways from a National Longitudinal Survey.

Electronic cigarette use among youth and young adults has reached an epidemic proportion of growth. This study examined the direct and indirect effects of the breadth of media scanning about e-cigarette use on subsequent vaping behavior through interpersonal communication and changes in descriptive norm perceptions. We conducted a nationally representative longitudinal phone survey of 13- to 25-year-olds from June 2014 to March 2017, with 11,013 respondents who completed a baseline survey, among which 3,212 completed a follow-up 6 months later. The results from both cross-sectional and lagged analyses provided robust evidence to suggest that passive routine exposure to e-cigarette use content from more media outlets predicted increased likelihood of vaping among youth and young adults. High scanners were about twice as likely to vape as non-scanners (17% versus 9%). Mediation models using bootstrapping procedures found that breadth of scanning predicted higher descriptive norm perceptions which were associated with subsequent vaping; in addition, interpersonal communication mediated the relationship between breadth of scanning and changes in descriptive norm perceptions. These findings highlight the important roles of scanning, norm perceptions and interpersonal discussions in shaping cognition and behavior changes. The results also suggest an overall pro-e-cigarette public communication environment, which warrants further examination.

The Relationship Between Exogenous Exposure to "The Real Cost" Anti-Smoking Campaign and Campaign-Targeted Beliefs.

Though previous evaluations of "The Real Cost" anti-smoking campaign demonstrate effects on anti-smoking beliefs and behaviors, results rely on self-reported recall as a measure of exposure and are thus open to reverse causation concerns. Exogenous measures of exposure, assessed independently of outcomes, support stronger causal inferences. In this study, we examined the relationship between Target Rating Points (TRPs) for specific ads available over four-week periods and anti-smoking beliefs in a national sample of adolescent nonsmokers and experimenters (n = 4,780). Results demonstrate positive relationships between TRPs for ads targeting two of four belief categories tested (Control and Chemical; p < .05) and targeted-belief endorsement. Furthermore, moderation models indicate that ad-specific TRPs affected targeted beliefs more than non-targeted beliefs for those Control- and Chemical-targeted ads (p < .01). Findings support a claim of campaign effects while reducing concerns about reverse causal direction and the influence of unmeasured confounders.

Combining Crowd-Sourcing and Automated Content Methods to Improve Estimates of Overall Media Coverage: Theme Mentions in E-cigarette and Other Tobacco Coverage.

Exposure to media content can shape public opinions about tobacco. Accurately describing content is a first step to showing such effects. Historically, content analyses have hand-coded tobacco-focused texts from a few media sources which ignored passing mention coverage and social media sources, and could not reliably capture over-time variation. By using a combination of crowd-sourced and automated coding, we labeled the population of all e-cigarette and other tobacco-related (including cigarettes, hookah, cigars, etc.) 'long-form texts' (focused and passing coverage, in mass media and website articles) and social media items (tweets and YouTube videos) collected May 2014-June 2017 for four tobacco control themes. Automated coding of theme coverage met thresholds for item-level precision and recall, event validation, and weekly-level reliability for most sources, except YouTube. Health, Policy, Addiction and Youth themes were frequent in e-cigarette long-form focused coverage (44%-68%), but not in long-form passing coverage (5%-22%). These themes were less frequent in other tobacco coverage (long-form focused (13-32%) and passing coverage (4-11%)). Themes were infrequent in both e-cigarette (1-3%) and other tobacco tweets (2-4%). Findings demonstrate that passing e-cigarette and other tobacco long-form coverage and social media sources paint different pictures of theme coverage than focused long-form coverage. Automated coding also allowed us to code the amount of data required to estimate reliable weekly theme coverage over three years. E-cigarette theme coverage showed much more week-to-week variation than did other tobacco coverage. Automated coding allows accurate descriptions of theme coverage in passing mentions, social media, and trends in weekly theme coverage.

Does Seeking e-Cigarette Information Lead to Vaping? Evidence from a National Longitudinal Survey of Youth and Young Adults.

Youth and young adults (YYAs) are vulnerable populations for e-cigarette use or vaping. This study examined the effect of YYAs' health information seeking behavior (HISB) around e-cigarette use and vaping on their subsequent vaping behavior. We conducted a nationally representative longitudinal phone survey of 13-25 year olds from June 2014 to September 2016, with 2,413 respondents who completed a baseline and follow-up survey six months later. The results from lagged logistic regressions and mediation analyses showed a) that information seeking predicted higher likelihood of vaping six months later even after controlling for baseline smoking and vaping status, intention to vape, and demographics, and b) that information seeking partially mediated the relationship between intention to vape and subsequent vaping behavior. Theoretical and regulatory implications are discussed.

No Effect of Commercial Cognitive Training on Brain Activity, Choice Behavior, or Cognitive Performance.

Increased preference for immediate over delayed rewards and for risky over certain rewards has been associated with unhealthy behavioral choices. Motivated by evidence that enhanced cognitive control can shift choice behavior away from immediate and risky rewards, we tested whether training executive cognitive function could influence choice behavior and brain responses. In this randomized controlled trial, 128 young adults (71 male, 57 female) participated in 10 weeks of training with either a commercial web-based cognitive training program or web-based video games that do not specifically target executive function or adapt the level of difficulty throughout training. Pretraining and post-training, participants completed cognitive assessments and functional magnetic resonance imaging during performance of the following validated decision-making tasks: delay discounting (choices between smaller rewards now vs larger rewards in the future) and risk sensitivity (choices between larger riskier rewards vs smaller certain rewards). Contrary to our hypothesis, we found no evidence that cognitive training influences neural activity during decision-making; nor did we find effects of cognitive training on measures of delay discounting or risk sensitivity. Participants in the commercial training condition improved with practice on the specific tasks they performed during training, but participants in both conditions showed similar improvement on standardized cognitive measures over time. Moreover, the degree of improvement was comparable to that observed in individuals who were reassessed without any training whatsoever. Commercial adaptive cognitive training appears to have no benefits in healthy young adults above those of standard video games for measures of brain activity, choice behavior, or cognitive performance.SIGNIFICANCE STATEMENT Engagement of neural regions and circuits important in executive cognitive function can bias behavioral choices away from immediate rewards. Activity in these regions may be enhanced through adaptive cognitive training. Commercial brain training programs claim to improve a broad range of mental processes; however, evidence for transfer beyond trained tasks is mixed. We undertook the first randomized controlled trial of the effects of commercial adaptive cognitive training (Lumosity) on neural activity and decision-making in young adults (N = 128) compared with an active control (playing on-line video games). We found no evidence for relative benefits of cognitive training with respect to changes in decision-making behavior or brain response, or for cognitive task performance beyond those specifically trained.

Recall of "The Real Cost" Anti-Smoking Campaign Is Specifically Associated With Endorsement of Campaign-Targeted Beliefs.

Though previous research suggests the FDA's "The Real Cost" anti-smoking campaign has reduced smoking initiation, the theorized pathway of effects (through targeted beliefs) has not been evaluated. This study assesses the relationship between recall of campaign television advertisements and ad-specific anti-smoking beliefs. Respondents in a nationally representative survey of nonsmoking youths age 13-17 (n = 4,831) reported exposure to four The Real Cost advertisements and a fake ad, smoking-relevant beliefs, and nonsmoking intentions. Analyses separately predicted each targeted belief from specific ad recall, adjusting for potential confounders and survey weights. Parallel analyses with non-targeted beliefs showed smaller effects, strengthening claims of campaign effects. Recall of four campaign ads (but not the fake ad) significantly predicted endorsement of the ad-targeted belief (Mean ß = .13). Two-sided sign tests indicated stronger ad recall associations with the targeted belief relative to the non-targeted belief (p < .05). Logistic regression analyses indicated that respondents who endorsed campaign-targeted beliefs were more likely to have no intention to smoke (p < .01). This study is the first to demonstrate a relationship between recall of ads from The Real Cost campaign and the theorized pathway of effects (through targeted beliefs). These analyses also provide a methodological template for showing campaign effects despite limitations of available data.

Effects of Framing Health Messages in Terms of Benefits to Loved Ones or Others: An Experimental Study.

Many health officials believe the future of public health is in prevention of infectious diseases like pandemic influenza. Vaccine promotion is becoming an increasingly important area for health communication researchers. One strategy health promoters can consider is to emphasize that getting vaccinated protects not only the self, but also loved ones, and unknown others to whom the disease could be spread. The set of experiments described here tested whether such a strategy (called "benefit-target framing") could prove useful in promoting vaccine intentions. In two experiments, subjects from an online panel were randomized to receive a vaccination message focused on the benefits either to the self, to loved ones, or to society as a whole. Outcome measures included intentions to receive the vaccine and intentions to seek more information (n = 495). Results from two virtually identical studies were pooled to maximize power. Results suggest that messages framed in terms of benefits to society were more successful than those focused on the self, but messages focused on loved ones were not different from either of the others. Possible explanations for the findings, and implications for future research, are discussed.

Nonmedical information seeking amid conflicting health information: negative and positive effects on prostate cancer screening.

This study investigates the impact of seeking information about the prostate-specific antigen (PSA) test on men's PSA test use during a period of conflicting recommendations. Analyses used longitudinal survey data collected in 2005 and 2006 from a nationally representative sample of U.S. males aged 40-70 years (n = 777). Cross-sectionally, nonmedical information seeking was significantly associated with increased odds of having a PSA test in the past year (Time 1 odds ratio [OR] = 9.74, p < .01, 95% confidence interval [CI] = 4.37, 21.70; Time 2 OR = 5.78, p < .01, 95% CI = 3.17, 10.55). However, lagged analyses showed that among men who had a PSA at Time 1, active seeking is associated with reduced odds of later having a PSA test (OR = 0.33, p < .05, 95% CI = 0.13, 0.85). Participants who had not had a PSA test in the past year very rarely sought information about PSA tests. Information acquisition in an environment of conflicting recommendations may influence adoption of cancer screening behaviors.

Media Coverage of Pediatric Environmental Health Risks and its Effects on Mothers' Protective Behaviors.

This study explores the relationship between exposure to U.S. media coverage of chemical threats to pediatric environmental health and mothers' behaviors to protect their children. Prior content analytic work revealed that media coverage volume from September 2012 to February 2013 differed significantly by type of chemical (i.e., pesticides = high coverage volume; bisphenol A [BPA] = moderate; and arsenic = low). Survey data collected from new and expecting mothers in March 2013 (n = 822) revealed mothers incidentally encountered-or scanned-this information in the media in the prior six months, and after adjusting for a series of potential confounders, such scanning was positively associated with mothers' self-reported behaviors to reduce chemical exposures. To test the hypothesis that coverage volume moderates the relationship between scanning and behavior, content analysis and survey data were combined in mixed effects regression analyses. Results showed significant differences between the effects of media scanning at different levels of coverage volume, but in a direction not entirely consistent with the study's hypothesis. The relationship between scanning and behavior was strongest for BPA, suggesting that a characteristic of media coverage other than volume may drive maternal responses to environmental health threats. Implications of these findings for risk communication research and practice are discussed.

Are young people's beliefs about menthol cigarettes associated with smoking-related intentions and behaviors?

INTRODUCTION: Little is known about the beliefs that youth and young adults hold about menthol cigarettes or the influence of these beliefs on tobacco use initiation. METHODS: Online cross-sectional surveys with 13- to 17-year-old current nonsmokers (n = 553) and 18- to 25-year-old never (n = 586) and current tobacco users (n = 307) in the United States assessed the association between endorsing each of 9 pro-menthol beliefs and (a) intentions to smoke menthol cigarettes over the next year, (b) current use of menthol cigarettes, (c) intentions to use tobacco in general over the next year, and (d) current use of tobacco products in general. RESULTS: Menthols were perceived to be less harmful and addictive than nonmenthol cigarettes by between 13% and 23% of respondents. Between 20% and 58% believed that menthols had favorable sensory properties, and 7%-25% believed that menthol smokers were more popular and attractive than nonmenthol smokers. Logistic regression analyses (adjusting for confounders) indicated that, on the whole, those who endorsed pro-menthol beliefs were more likely to intend to use, and to currently use, both menthols and tobacco products in general. For example, respondents who believed that menthol cigarettes were more refreshing in sensation (one of the most frequently endorsed beliefs) were significantly more likely to (a) intend to smoke menthol cigarettes (13- to 17-year-olds, odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.03, 4.34; 18- to 25-year olds, OR = 2.62, 95% CI = 1.04, 6.60), (b) currently use menthol cigarettes (18- to 25-year olds, OR = 3.40, 95% CI = 2.20, 5.26), (c) intend to use tobacco (13- to 17-year-olds OR = 1.74, 95% CI = 1.14, 2.65), and (d) currently use tobacco (18- to 25-year olds, OR = 2.06, 95% CI = 1.44, 2.93). CONCLUSIONS: Youth and young adults who do not currently smoke and who hold favorable beliefs about menthol cigarettes are at greater risk for beginning to use tobacco products, indicating that the availability of menthol cigarettes may contribute to tobacco use initiation. These findings support recent claims that the elimination of menthol cigarettes would improve public health in the United States.