Publications by authors named "Donna Vallone"

156 Publications

A Comprehensive Qualitative Review of Studies Evaluating the Impact of Local US Laws Restricting the Sale of Flavored and Menthol Tobacco Products.

Nicotine Tob Res 2021 Sep 15. Epub 2021 Sep 15.

Truth Initiative Schroeder Institute, Washington, DC USA.

Objectives: To assess the quality of evidence on the effectiveness of local US laws restricting the sale of flavored tobacco products.

Methods: We conducted a systematic search and qualitative scoping review of English-language papers published through May 2020 that evaluated flavored tobacco sales policies implemented by US jurisdictions during 2010-2019. We constructed a conceptual model for flavored and menthol tobacco sales restriction outcomes, assigned GRADE quality of evidence ratings to policy outcomes evaluated through the included studies, and summarized factors that might explain weak or inconsistent findings.

Results: We found moderate to high quality of evidence associating policy implementation with reduced availability, marketing, and sales of policy-restricted products, and decreased youth and adult tobacco use of these products; however, policy exclusions and exemptions, implementation challenges, tobacco industry actions (e.g., marketing of concept-named flavored products; exploiting policy exemptions for certain store types), and consumer responses (e.g., cross-border or illicit purchasing) might undermine or mitigate intended policy effects.

Conclusions: Flavored and menthol tobacco product sales restrictions implemented and evaluated in US jurisdictions appear to have achieved some of their intended outcomes; however, deficiencies in study designs, methods, and metrics could contribute to equivocal findings on quality of evidence associating policy implementation and outcomes. Gaps in the evidence are beginning to be filled with research using more rigorous study designs, improved measurement and analytic methods, and longer-term follow-up.

Implications: In the absence of comprehensive federal action, US jurisdictions have the obligation to restrict flavored and menthol product sales to protect vulnerable populations from tobacco-related harms. The considerable expenditure of financial resources, political will, and time dedicated to policy adoption and implementation argue for evaluation studies designed to maximize the quality of evidence. This review offers generalizable insights into evaluation findings that can inform efforts to enhance tobacco control policy implementation and impact in the US and globally.
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http://dx.doi.org/10.1093/ntr/ntab188DOI Listing
September 2021

Early evidence of the associations between an anti-e-cigarette mass media campaign and e-cigarette knowledge and attitudes: results from a cross-sectional study of youth and young adults.

Tob Control 2021 Jul 21. Epub 2021 Jul 21.

Truth Initiative Schroeder Institute, Washington, DC, USA.

Objective: Antismoking mass media campaigns have contributed to significant declines in combustible tobacco use among young people. This study evaluates a national anti-e-cigarette campaign to determine its association with knowledge, attitudes and beliefs in the context of increasing e-cigarette use in the USA.

Methods: A national sample of respondents aged 15-24 years (n=8421) was drawn from a repeated cross-sectional online panel survey (220 participants/week) (October 2018 to December 2019). Self-reported exposure to the truth anti-e-cigarette campaign was measured according to level of ad awareness. Outcomes were subjective knowledge of campaign-targeted facts about e-cigarettes and attitudinal constructs about perceived e-cigarette harm, social unacceptability and anti-industry sentiments. Covariates included respondent demographics, current e-cigarette use and cigarette use, parental smoking, sensation seeking, mental health and growth in e-cigarette sales.

Results: Ad awareness was associated with knowledge that e-cigarette users are more likely to start smoking (low OR: 1.28, 95% CI 1.14 to 1.44; high OR: 1.88, 95% CI 1.66 to 2.13) and of the nicotine content of JUUL compared with cigarettes (low OR: 1.63, 95% CI 1.45 to 1.82; high OR: 2.50, 95% CI 2.21 to 2.84). High ad awareness was associated with knowledge that the long-term health effects of JUUL use are unknown (OR: 1.88, 95% CI 1.57 to 2.28). High ad awareness was associated with significantly higher perceived product harm (OR: 1.35, 95% CI 1.18 to 1.54), social unacceptability (OR: 1.32, 95% CI 1.15 to 1.53) and anti-industry attitudes (OR: 1.40, 95% CI 1.21 to 1.62), compared with respondents with no awareness.

Conclusions: Young people with awareness of anti-e-cigarette ads demonstrate higher levels of campaign-targeted knowledge, attitudes and beliefs. Future campaign evaluation priorities include measuring the campaign effects on e-cigarette use behaviours.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056047DOI Listing
July 2021

Evidence of the impact of a national anti-tobacco prevention campaign across demographic subgroups.

Health Educ Res 2021 Jul 5. Epub 2021 Jul 5.

Schroeder Institute at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA.

Mass media campaigns are an effective population-level intervention for preventing tobacco use. However, little evidence exists for whether these campaigns similarly influence demographic subgroups. This study examined the effects of the truth® campaign to reduce tobacco use among demographic subgroups. We used data from a national, continuous, cross-sectional tracking survey of 15-24-year-olds (n = 32 331). We used a measure of weekly aggregated campaign exposure to assess whether cigarette smoking intentions and current cigarette use varied by race/ethnicity, financial situation and population density subgroups, controlling for factors known to be associated with tobacco use. Examining estimates across subgroup categories in light of the overall model estimates revealed that the effects of week-level campaign exposure on cigarette smoking intentions and current cigarette use were similar across subgroups. Wald tests of equality across estimates in each subgroup suggested that the estimates did not differ from one another in any given instance. The truth campaign does not differ significantly in its capacity to prompt declines in tobacco use across a broad spectrum of US youth and young adults. Mass media tobacco prevention campaigns can be an effective and critical component of a comprehensive tobacco control program, particularly with respect to reducing tobacco-related disparities among demographic subgroups.
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http://dx.doi.org/10.1093/her/cyab025DOI Listing
July 2021

A longitudinal analysis of e-cigarette use and cigar, little cigar or cigarillo initiation among youth and youth adults: 2017-2019.

Drug Alcohol Depend 2021 Sep 23;226:108821. Epub 2021 Jun 23.

Schroeder Institute at Truth Initiative, Washington, DC, USA; School of Global Public Health, New York University, New York, NY, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Purpose: To examine whether youth and young adult e-cigarette use is associated with initiation of cigars, little cigars, or cigarillos (CLCCs) and current use of flavored CLCCs.

Basic Procedures: The sample is drawn from the Truth Longitudinal Cohort, a probability-based longitudinal cohort of youth and young adults recruited at ages 15-21 and surveyed every six months. The sample for this study was CLCC-naïve defined as those who had never used CLCCs as of 2017 (N = 5586). The outcomes were the odds of (1) initiating any CLCC use and (2) reporting current (past 30-day) use of flavored CLCCs from 2018 to late 2019. The main predictor was use of e-cigarettes by 2018.

Results: The odds of initiating a CLCC was greater for those who had used ever used JUUL (OR: 3.30, p < 0.001) or were current users of another type of e-cigarette by 2018 (OR: 3.57, p < 0.001). Odds of CLCC initiation was also greater for those who had ever used combustible cigarettes (OR: 1.62, p < 0.05), were current smokers (OR: 3.12, p < 0.001) or had used marijuana (OR: 1.92, p < 0.001) by 2018. E-cigarette use that occurred by 2018 was associated with greater odds of current use of flavored CLCCs compared to non-flavored CLCCs (ever users of JUUL: OR: 2.57, p < 0.01; current users of some other e-cigarette: OR: 3.06, p < 0.05).

Conclusion And Relevance: This study raises new concerns about the effects of e-cigarette use on subsequent combustible tobacco use. Restrictions on CLCCs should be considered in conjunction with current policies designed to reduce the youth vaping epidemic.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108821DOI Listing
September 2021

Effects of branded health messages on e-cigarette attitudes, intentions, and behaviors: a longitudinal study among youth and young adults.

BMC Public Health 2021 06 15;21(1):1144. Epub 2021 Jun 15.

Truth Initiative Schroeder Institute®, Washington, DC, USA.

Background: Launched in 2000, the truth campaign was one of the first health-related campaigns to embrace the building of a brand to further amplify its message, such as by building brand equity. Brand equity is an asset that represents the audience's perception of the brand. Previous research supports that strong brand equity is associated with lower tobacco intentions and behaviors; however, brand equity and its change over time have not been studied as it relates to e-cigarettes. This study examines the effects of change in brand equity on e-cigarette attitudes, intentions, and behaviors among youth and young adults.

Methods: The sample (N = 6427) is from the Truth Longitudinal Cohort, a nationally representative, longitudinal cohort of youth and young adults, ages 15-24. Variables include brand equity tobacco scale, demographic characteristics, and e-cigarette use status. The outcomes included anti-e-cigarette attitudes, intentions to use e-cigarettes, and use of e-cigarettes. Multiple and logistic regression models determined the relationship between change in brand equity from respondents at Spring 2018 to Spring 2019 and respondent e-cigarette outcomes at Fall 2019. All models controlled for demographic characteristics and cigarette use.

Results: Mean brand equity scores in Spring 2018 were significantly associated with greater anti-e-cigarette attitudes (β = 0.17, 95% CI: 0.15, 0.19), lower odds of intention to use (OR = 0.75, 95% CI: 0.66, 0.85), and lower odds of current use (OR = 0.81, 95% CI: 0.72, 0.92). Change in brand equity from Spring 2018 to Spring 2019 was significantly associated with greater anti-e-cigarette attitudes (β = 0.09, 95% CI: 0.06, 0.11) and lower odds of intention to use (OR = 0.79, 95% CI: 0.67, 0.93), but not associated with current use behaviors.

Conclusions: Strengthening brand equity is an effective strategy for influencing anti-e-cigarette related attitudes and intentions, much like it is for anti-smoking campaigns. More research needs to be done on the relationship between change in brand equity and e-cigarette behavior to better understand how brand equity can be wielded to influence change in e-cigarette use behavior.
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http://dx.doi.org/10.1186/s12889-021-11092-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207642PMC
June 2021

Identifying message themes to prevent e-cigarette use among youth and young adults.

Prev Med 2021 09 10;150:106683. Epub 2021 Jun 10.

Schroeder Institute at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA; School of Global Public Health, New York University, 665 Broadway, Eleventh Floor, New York, NY 10012, USA. Electronic address:

In 2020, almost 20% of high school students reported current e-cigarette use. Mass media tobacco prevention campaigns are effective for preventing tobacco use among youth and young adults but selecting messages that will have maximum impact on the target audience is a significant challenge for campaign developers. This study describes the method for identification of potential messaging targets for a national anti-vape mass media campaign using criteria proposed by Hornik and Woolf in their health communication framework. A national sample of 15- to 24-year-olds (N = 1564) was recruited via an online panel in May 2020. Participants endorsed a series of vape-related attitudinal items. Items were considered potential message targets if they distinguished between the four vape use groups (current users, ever users, susceptible never-users, and non-susceptible never-users) and if less than 70% of respondents endorsed the anti-vape item response. The resulting items targeted five potential message themes, each forming a scale measured with three to four individual items. Message themes included social acceptability of vaping, anti-vape industry sentiment, independence from vaping, non-vaping identity, and perceived risk of harm. Findings were used to inform the development of truth® campaign messaging focused on reducing the prevalence of e-cigarette use among youth and young adults.
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http://dx.doi.org/10.1016/j.ypmed.2021.106683DOI Listing
September 2021

Support for cigarette filter waste policies among US adults.

Tob Control 2021 Jun 8. Epub 2021 Jun 8.

Graduate School of Public Health, San Diego State University, San Diego, California, USA.

Introduction: Little is known on whether cigarette filter-related knowledge or beliefs are associated with support for policies to reduce their environmental impact.

Methods: A cross-sectional, population-based sample of US adults aged 18-64 years (n=2979) was used to evaluate filter-related knowledge and beliefs by smoking status using data collected between 24 October 2018 and 17 December 2018. Multivariate logistic regression models explored whether these knowledge and belief items were associated with support for two policies, a US$0.75 litter fee and a ban on sales of filtered cigarettes, controlling for demographic characteristics and smoking status.

Results: Regardless of smoking status, 71% did not know plastic was a cigarette filter component and 20% believed filters were biodegradable. Overall, 23% believed filters reduce health harms and 60% believed filters make it easier to smoke; 90% believed cigarette butts are harmful to the environment. Individuals believing cigarette butts harmed the environment were more likely to support a litter fee (adjusted OR (aOR)=2.33, 95% CI: 1.71 to 3.17). Individuals believing that filters are not biodegradable had higher odds of supporting a litter fee (OR=1.47, 95% CI: 1.15 to 1.88). Respondents believing that filters do not make cigarettes less harmful were more likely to support a litter fee (aOR=1.50, 95% CI: 1.20 to 1.88) and filter ban (aOR=2.03, 95% CI: 1.64 to 2.50). Belief that filters make it easier to smoke was associated with decreased support for a filter ban (aOR=0.69, 95% CI: 0.58 to 0.83).

Conclusions: Comprehensive efforts are needed to educate the public about the impact of cigarette filters in order to build support for effective tobacco product waste policy.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056451DOI Listing
June 2021

Shifting the National Consciousness about Pain Treatment: The Critical Need for a National Public Education Campaign.

J Pain 2021 May 1. Epub 2021 May 1.

Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California; Departments of Medicine and Health Policy and Management, UCLA, Los Angeles; California.

The failure of past practices and policies related to opioid prescribing for chronic pain has led federal agencies and professional organizations to recommend multimodal approaches that prioritize evidence-based nonpharmacological pain treatments (NPTs). These multimodal approaches, which include both traditional and complementary/integrative approaches, hold great promise for reducing the burden of chronic pain and reducing opioid use. Unfortunately, NPT approaches are underutilized due to a daunting array of interrelated barriers including the public's attitudes and beliefs about chronic pain and its treatment. Given the dual crises of chronic pain and opioid use, there is a critical need for a national public health campaign on chronic pain and its treatment to help educate the American public about NPT pain management options, while countering the misleading messages promulgated by the pharmaceutical industry, including but not limited to messages promoting the broad use of prescription opioids and minimizing its risks. Despite these dual crises of chronic pain and opioid use in the U.S., there has never been a concerted effort to broadly educate the American public about these issues and NPT pain management options.
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http://dx.doi.org/10.1016/j.jpain.2021.03.156DOI Listing
May 2021

E-Cigarette Use Among Youths and Young Adults During the COVID-19 Pandemic: United States, 2020.

Am J Public Health 2021 06 15;111(6):1132-1140. Epub 2021 Apr 15.

All authors are with the Schroeder Institute at Truth Initiative, Washington, DC.

To determine whether the COVID-19 pandemic affected e-cigarette use among young people in the United States. Data came from a weekly cross-sectional online survey of youths and young adults (aged 15-24 years). Logistic regression analyses measured odds of past-30-day e-cigarette use (n = 5752) following widespread stay-at-home directives (March 14-June 29, 2020), compared with the pre‒COVID-19 period (January 1-March 13, 2020). Logistic regression among a subsample of current e-cigarette users (n = 779) examined factors associated with reduced use following stay-at-home orders. Odds of current e-cigarette use were significantly lower during the COVID-19 pandemic compared with the pre‒COVID-19 period among youths aged 15 to 17 years (odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.54, 0.96) and young adults aged 18 to 20 years (OR = 0.65; 95% CI = 0.52, 0.81). E-cigarette users with reduced access to retail environments had higher odds of reporting reduced e-cigarette use (OR = 1.51; 95% CI = 1.07, 2.14). COVID-19 stay-at-home directives present barriers to e-cigarette access and are associated with a decline in e-cigarette use among young people. Findings support the urgent implementation of interventions that reduce underage access to e-cigarettes to accelerate a downward trajectory of youth and young adult e-cigarette use.
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http://dx.doi.org/10.2105/AJPH.2021.306210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101576PMC
June 2021

Quitting e-cigarettes: Quit attempts and quit intentions among youth and young adults.

Prev Med Rep 2021 Mar 5;21:101287. Epub 2021 Jan 5.

Truth Initiative Schroeder Institute, 900 G St NW Fourth Floor, Washington, DC 20001, United States.

While youth and young adult e-cigarette use has risen in the U.S., few studies have explored e-cigarette cessation behavior. This study estimates quit attempts and intentions among young people (aged 15-36) since the rise of high-nicotine products, and examines factors associated with e-cigarette quit attempts and intentions. Current e-cigarette users (past 30-day use, not already quit) were drawn from a national probability-based cohort sample. Data were collected from September to December 2019 (n = 1158). Weighted proportions of past-year quit attempts, intentions to quit in next 30 days, and general intentions to quit (at some point) were calculated. Models estimated cessation outcomes with respect to harm perceptions, friend use, dependence, use frequency, combustible use and demographic factors. Among current e-cigarette users, 54.2% reported general intentions to quit, 15.3% reported intention to quit within 30 days, and 33.3% reported a past-year quit attempt. Past-year quit attempts were associated with higher levels of harm perceptions (adjusted odds ratio (aOR) = 2.08, 95% confidence interval (CI): 1.49-2.92), dependence (aOR = 1.92, 95% CI: 1.44-2.56) and daily use (28 + days) compared to infrequent use (1-5 days) (aOR = 0.23, 95% CI: 0.12-0.43). General intentions to quit were positively associated with harm perceptions (aOR = 1.77, 95% CI: 1.23-2.56) and dependence (aOR = 1.89, 95% CI: 1.41-2.52), and negatively associated with daily use compared to infrequent use (aOR = 0.35, 95% CI: 0.19-0.65). Findings indicate that over half of young e-cigarette users want to quit, highlighting a critical need for policies and resources to promote and sustain e-cigarette cessation among young people.
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http://dx.doi.org/10.1016/j.pmedr.2020.101287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808959PMC
March 2021

Youth and young adult risk perceptions and behaviours in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA.

Tob Control 2021 Jan 13. Epub 2021 Jan 13.

Schroeder Institute, Truth Initiative, Washington, DC, USA.

Objective: To determine whether awareness of emerging vaping-attributable health conditions influences vaping-related risk perceptions and behaviours among young people.

Design: Respondents aged 15-24 years (n=3536) were drawn from a repeated cross-sectional online panel survey (222 participants/week) during an e-cigarette/vaping-associated lung injury (EVALI) outbreak in the USA (September 2019-January 2020). Logistic regression models tested for associations between EVALI awareness and perceived lung injury risk and product harm, stratified by e-cigarette/vape use and controlling for awareness of other e-cigarette/vaping news stories, demographic characteristics and outbreak week. Other models measured the association between perceived risk of lung injury and intentions to use (non-users) or intentions to quit (current users) e-cigarettes/vape products. Changes in national retail e-cigarette sales data were examined during national EVALI outbreak reporting.

Results: EVALI awareness was associated with: perceived risk of lung injury (current users OR 1.59, p=0.004; non-users OR 2.11, p<0.001); belief that e-cigarettes/vapes contain dangerous chemicals (current users OR 1.47, p=0.017; non-users OR 1.88, p<0.001) and belief that e-cigarettes/vapes are harmful (current users OR 1.66, p=0.002; non-users OR 1.67, p<0.001). Perceived risk of lung injury from e-cigarette/vape use was associated with intentions to own e-cigarette/vape products (ever-users OR 0.25, p<0.001; never-users OR 0.61, p=0.004) and intentions to quit among current users (OR 2.02, p=0.002). Declines in e-cigarette sales were observed following news of the EVALI outbreak.

Conclusions: News of vaping-attributable health conditions may prevent e-cigarette/vape use and encourage cessation among young people. Tobacco control campaigns should address uncertain health effects of e-cigarettes or vape products and align with risk communication by public health agencies during outbreaks.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056090DOI Listing
January 2021

The Authors Respond.

J Adolesc Health 2021 01;68(1):216-221

Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.

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http://dx.doi.org/10.1016/j.jadohealth.2020.10.017DOI Listing
January 2021

Effects of Multiple Exposures and Ad-Skipping Behavior on Recall of Health Messages on YouTube.

Int J Environ Res Public Health 2020 11 14;17(22). Epub 2020 Nov 14.

Schroeder Institute, Truth Initiative, Washington, DC 20001, USA.

Although measuring exposure to public health messages is key to understanding campaign effectiveness, little is known about how exposure to and avoidance of digital ad messages may influence self-reported ad recall. A sample of 15-24-year-olds ( = 297) received a varying number of forced-view and skippable test ads across multiple simulated YouTube sessions. Each session was coded for whether the participant viewed the ad or skipped it. While a majority of participants recalled the test ad, the odds of ad recall did not vary by number of sessions (opportunities for exposure). Rather, ad recall was sensitive to the number of completed ad views such that odds of ad recall doubled for each additional time the ad was completely viewed. Findings suggest that public health digital message exposure and recall can be optimized with sufficient attention paid to the proportions of forced-view ads aired when aiming to reach younger audiences.
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http://dx.doi.org/10.3390/ijerph17228427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696643PMC
November 2020

National Support for a Menthol Cigarette Sales Ban.

Public Health Rep 2021 Mar-Apr;136(2):183-191. Epub 2020 Nov 9.

531118 Schroeder Institute at Truth Initiative, Washington, DC, USA.

Objectives: The US Food and Drug Administration (FDA) and local jurisdictions have different authorities to regulate menthol cigarettes, and a growing number of localities and the FDA are considering these policy options. The objective of this study was to update previous research on public support for a menthol ban, including examining differences in support by demographic factors, geographic region, and smoking status.

Methods: We assessed policy support among a cross-sectional sample of 2871 adults aged 18-64 from a nationally representative online panel. We calculated weighted estimates of support by demographic factors, political ideology, region (Northeast, Midwest, South, West), and smoking status (never, former, current nonmenthol, current menthol). We used weighted adjusted logistic regression analysis to examine correlates of support for a menthol ban.

Results: Overall, 56.4% (95% CI, 54.4%-58.3%) of participants supported a government policy to ban menthol cigarette sales. Support was significantly higher among women than among men (62.5% vs 50.1%; < .001); among Hispanic/Latino (69.3%), non-Hispanic African American (60.5%), and non-Hispanic other (65.8%) people than among non-Hispanic White people (50.4%; < .001); and among never (64.8%) and former (47.0%) smokers than among current nonmenthol cigarette smokers (30.1%; < .001). A significant proportion (28.5%; < .001) of current menthol cigarette smokers supported a ban. After controlling for other factors, geographic region was not significantly associated with support for a ban.

Conclusions: Efforts are needed to further increase support for a ban among current menthol cigarette smokers. These findings can be used to assist policy makers and communities in efforts to ban menthol cigarettes in their jurisdictions.
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http://dx.doi.org/10.1177/0033354920966004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093834PMC
July 2021

Public Support for E-Cigarette-related Policies among a Nationally Representative Sample of US Adults.

Tob Use Insights 2020 9;13:1179173X20959700. Epub 2020 Oct 9.

Schroeder Institute at Truth Initiative, Washington, DC, USA.

Background: The wide availability of flavored e-cigarettes and broad use of e-cigarettes in public places may contribute to the rapidly increasing rates of use among youth and young adults in the U.S. However, policies at the federal, state and local levels can address these factors.

Objective: Assess public support for 5 e-cigarette-related policies and evaluate response patterns by demographics, tobacco use, e-cigarette harm perceptions, geographic region, and strength of state-level clean indoor air policies.

Methods: Data were collected Oct-Dec 2018 from a nationally representative online panel of U.S. adults (n = 3211). We measured support for 5 policies: (1) a ban on the sale flavored e-cigarettes; (2) requiring tobacco products, like e-cigarettes, be kept out of view in stores where adolescents shop; and prohibiting e-cigarette use in (3) all public places; (4) restaurants; and (5) bars. Weighted, adjusted logistic regressions modeled variation in policy support.

Results: A majority of respondents (63.3%) supported a flavor ban, with no differences in support by smoking status. Most respondents supported keeping tobacco products out of view (78.0%) and prohibiting e-cigarette use in indoor public places (82.9%), restaurants (86.5%), and bars (76.1%). In the adjusted models, current e-cigarette users had significantly lower odds of policy support compared to never users. We observed no differences in support by geographic region or strength of state-level clean indoor air policies.

Conclusion: Results suggest high levels of public support to regulate e-cigarette flavors, marketing, and use in public places. Targeted messaging may be needed to increase support among current e-cigarette users.
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http://dx.doi.org/10.1177/1179173X20959700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549073PMC
October 2020

Menthol e-cigarette sales rise following 2020 FDA guidance.

Tob Control 2020 Sep 23. Epub 2020 Sep 23.

Schroeder Institute, Truth Initiative, Washington, DC, USA.

Objective: To explore patterns in flavoured e-cigarette sales following Juul Labs' 2019 removal of mint-flavoured products and the Food and Drug Administration's (FDA) 2020 e-cigarette flavour guidance which prohibits flavoured cartridge-based sales, but allows for the sale of tobacco-flavoured and menthol-flavoured cartridges, open-system and disposable e-cigarettes.

Methods: We examined Nielsen Retail Scanner data from September 2013 to March 2020. Inflation-adjusted sales dollars for e-liquid-containing products were classified into five flavour categories (fruit, menthol, mint, tobacco and other).

Results: Following the Juul Labs 2019 and FDA 2020 actions, total e-cigarette sales declined; however, menthol-flavoured e-cigarette sales dollars increased, while mint-flavoured e-cigarette sales dollars decreased in both instances. Juul Labs' removal of mint-flavoured products was followed by a 59.4% increase in the market share of menthol-flavoured e-cigarettes over 4 weeks. The FDA's 2020 guidance was followed by a 54.5% increase in the market share of menthol-flavoured e-cigarettes over 4 weeks and a 82.8% increase over 8 weeks.

Conclusions: Juul Labs' self-regulation and the current FDA flavour guidance were followed by a shift towards menthol-flavoured e-cigarettes. Industry self-regulation and current federal guidance appear insufficient in reversing the youth vaping epidemic. E-cigarettes must be fully regulated as a tobacco product including the removal of flavoured e-cigarettes, including menthol, from the market to reduce youth e-cigarette use.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056053DOI Listing
September 2020

E-cigarette Unit Sales, by Product and Flavor Type - United States, 2014-2020.

MMWR Morb Mortal Wkly Rep 2020 Sep 18;69(37):1313-1318. Epub 2020 Sep 18.

Since electronic cigarettes (e-cigarettes) entered the U.S. marketplace in 2007, the landscape has evolved to include different product types (e.g., prefilled cartridge-based and disposable products) and flavored e-liquids (e.g., fruit, candy, mint, menthol, and tobacco flavors), which have contributed to increases in youth use (1,2). E-cigarettes have been the most commonly used tobacco product among U.S. youths since 2014; in 2019, 27.5% of high school students reported current e-cigarette use (3). To assess trends in unit sales of e-cigarettes in the United States by product and flavor type, CDC, CDC Foundation, and Truth Initiative analyzed retail scanner data during September 14, 2014-May 17, 2020, from Information Resources, Inc. (IRI). During this period, total e-cigarette sales increased by 122.2%, from 7.7 million to 17.1 million units per 4-week interval. By product type, the proportion of total sales that was prefilled cartridge products increased during September 2014-August 2019 (47.5% to 89.4%). During August 2019-May 2020, the proportion of total sales that was disposable products increased from 10.3% to 19.8%, while the proportion that was prefilled cartridge products decreased (89.4% to 80.2%). Among prefilled cartridge sales, the proportion of mint sales increased during September 2014-August 2019 (<0.1% to 47.6%); during August 2019-May 2020, mint sales decreased (47.6% to 0.3%), as menthol sales increased (10.7% to 61.8%). Among disposable e-cigarette sales during September 2014-May 2020, the proportion of mint sales increased (<0.1% to 10.5%), although tobacco-flavored (52.2% to 17.2%) and menthol-flavored (30.3% to 10.2%) sales decreased; during the same period, sales of all other flavors combined increased (17.2% to 62.1%). E-cigarette sales increased during 2014-2020, but fluctuations occurred overall and by product and flavor type, which could be attributed to consumer preferences and accessibility. Continued monitoring of e-cigarette sales and use is critical to inform strategies at the national, state, and community levels to minimize the risks of e-cigarettes on individual- and population-level health. As part of a comprehensive approach to prevent and reduce youth e-cigarettes use, such strategies could include those that address youth-appealing product innovations and flavors.
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http://dx.doi.org/10.15585/mmwr.mm6937e2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498168PMC
September 2020

Association between e-cigarette use and future combustible cigarette use: Evidence from a prospective cohort of youth and young adults, 2017-2019.

Addict Behav 2021 01 31;112:106593. Epub 2020 Jul 31.

Schroeder Institute at Truth Initiative, Washington, DC, USA; Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; College of Global Public Health, New York University, New York, NY, USA.

Introduction: A surge in popularity of e-cigarettes prompts concern given the association between e-cigarettes and future cigarette use. However, much of the evidence for this association comes from early, less efficient, and lower nicotine e-cigarettes than are available and widely used now. The goal of this study was to examine the relationship between e-cigarette use in 2018 and subsequent smoking initiation and continued e-cigarette use.

Methods: Participants included members of a national longitudinal panel of youth and young adults aged 15-27 who, in 2017, reported never having used a nicotine containing product (n = 3360). Logistic regression analyses assessed associations between participants' self-reported ever e-cigarette use in 2018 and ever cigarette use, current cigarette use, and current e-cigarette use in 2019, after controlling for demographic and psychosocial variables.

Results: Compared with those who still had never used an e-cigarette, those who reported ever e-cigarette use in 2018 had significantly higher odds of ever cigarette use (aOR = 7.29, 95% CI [4.10, 12.97]), current cigarette use (aOR = 8.26, 95% CI [3.17, 21.53]), and current e-cigarette use (aOR = 9.70, 95% CI [6.41, 14.69]) one year later in 2019.

Conclusions: These findings show that the pod mod style, high nicotine containing e-cigarettes subject young users to the same risks of transitioning to combustible cigarettes as their earlier, less efficient predecessors. Strong regulation of all nicotine products, including e-cigarettes, is needed to prevent the trajectory of e-cigarette to cigarette use among youth and young adults.
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http://dx.doi.org/10.1016/j.addbeh.2020.106593DOI Listing
January 2021

Exposure to tobacco content in episodic programs and tobacco and E-cigarette initiation.

Prev Med 2020 10 1;139:106169. Epub 2020 Aug 1.

Schroeder Institute at Truth Initiative, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, USA.

While prior research suggests a relationship between exposure to tobacco content in movies and smoking, less is known about the impact of exposure to tobacco through episodic programs. This study assessed the relationship between exposure to tobacco content in programs on Netflix and broadcast or cable TV and initiation of combustible tobacco or e-cigarette use among young people. A nationally representative, longitudinal sample (ages 15-21 at baseline) was surveyed about exposure to episodic programs previously analyzed for the presence of tobacco and subsequent use of combustible tobacco and e-cigarettes. Logistic regression models assessed associations between exposure to tobacco imagery and future initiation of combustible tobacco and e-cigarettes among those who were nicotine naïve (N = 4604). Data were collected in February-May 2018 and February-May 2019. All analyses were conducted in 2019. Results suggest a dose-response relationship between exposure to tobacco and vaping initiation, whereby the higher the exposure, the greater the odds of subsequent initiation (OR(low) = 2.19, 95%CI = 1.38-3.48; OR(medium) = 2.20, 95%CI = 1.34-3.64; OR(high) = 3.17, 95%CI = 1.71-5.88). There was no significant association between exposure to tobacco imagery and smoking initiation. Tobacco imagery is common in episodic programming popular among young people. Results suggest exposure to tobacco in episodic programs may impact future e-cigarette use. Ongoing monitoring of the impact of tobacco content in episodic programs is needed as the number of available programs continues to increase. Findings highlight the need for policy and advocacy efforts to reduce young people's exposure to tobacco content across all media platforms.
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http://dx.doi.org/10.1016/j.ypmed.2020.106169DOI Listing
October 2020

Sociodemographic Disparities in the Tobacco Retail Environment in Washington, DC: A Spatial Perspective.

Ethn Dis 2020 9;30(3):479-488. Epub 2020 Jul 9.

Schroeder Institute at Truth Initiative, Washington, DC.

Objective: Studies assessing sociodemographic disparities in the tobacco retail environment have relied heavily on non-spatial analytical techniques, resulting in potentially misleading conclusions. We utilized a spatial analytical framework to evaluate neighborhood sociodemographic disparities in the tobacco retail environment in Washington, DC (DC) and the DC metropolitan statistical area (DC MSA).

Methods: Retail tobacco availability for DC (n=177) and DC MSA (n=1,428) census tract was assessed using adaptive-bandwidth kernel density estimation. Density surfaces were constructed from DC (n=743) and DC MSA (n=4,539) geocoded tobacco retailers. Sociodemographics were obtained from the 2011-2015 American Community Survey. Spearman's correlations between sociodemographics and retail density were computed to account for spatial autocorrelation. Bivariate and multivariate spatial lag models were fit to predict retail density.

Results: DC and DC MSA neighborhoods with a higher percentage of Hispanics were positively correlated with retail density (rho = .3392, P = .0001 and rho = .1191, P = .0000, respectively). DC neighborhoods with a higher percentage of African Americans were negatively correlated with retail density (rho = -.3774, P = .0000). This pattern was not significant in DC MSA neighborhoods. Bivariate and multivariate spatial lag models found a significant inverse relationship between the percentage of African Americans and retail density (Beta = -.0133, P = .0181 and Beta = -.0165, P = .0307, respectively).

Conclusions: Associations between neighborhood sociodemographics and retail density were significant, although findings regarding African Americans are inconsistent with previous findings. Future studies should analyze other geographic areas, and account for spatial autocorrelation within their analytic framework.
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http://dx.doi.org/10.18865/ed.30.3.479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360184PMC
April 2021

The Importance of Including Youth Research in Premarket Tobacco Product and Modified Risk Tobacco Product Applications to the Food and Drug Administration.

J Adolesc Health 2020 09 14;67(3):331-333. Epub 2020 Jul 14.

Schroeder Institute at Truth Initiative, Washington, DC; New York University College of Global Public Health, New York, New York.

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http://dx.doi.org/10.1016/j.jadohealth.2020.06.020DOI Listing
September 2020

The Potential of Smartphone Apps in Informing Protobacco and Antitobacco Messaging Efforts Among Underserved Communities: Longitudinal Observational Study.

J Med Internet Res 2020 07 7;22(7):e17451. Epub 2020 Jul 7.

Dana-Farber Cancer Institute, Boston, MA, United States.

Background: People from underserved communities such as those from lower socioeconomic positions or racial and ethnic minority groups are often disproportionately targeted by the tobacco industry, through the relatively high levels of tobacco retail outlets (TROs) located in their neighborhood or protobacco marketing and promotional strategies. It is difficult to capture the smoking behaviors of individuals in actual locations as well as the extent of exposure to tobacco promotional efforts. With the high ownership of smartphones in the United States-when used alongside data sources on TRO locations-apps could potentially improve tobacco control efforts. Health apps could be used to assess individual-level exposure to tobacco marketing, particularly in relation to the locations of TROs as well as locations where they were most likely to smoke. To date, it remains unclear how health apps could be used practically by health promotion organizations to better reach underserved communities in their tobacco control efforts.

Objective: This study aimed to demonstrate how smartphone apps could augment existing data on locations of TROs within underserved communities in Massachusetts and Texas to help inform tobacco control efforts.

Methods: Data for this study were collected from 2 sources: (1) geolocations of TROs from the North American Industry Classification System 2016 and (2) 95 participants (aged 18 to 34 years) from underserved communities who resided in Massachusetts and Texas and took part in an 8-week study using location tracking on their smartphones. We analyzed the data using spatial autocorrelation, optimized hot spot analysis, and fitted power-law distribution to identify the TROs that attracted the most human traffic using mobility data.

Results: Participants reported encountering protobacco messages mostly from store signs and displays and antitobacco messages predominantly through television. In Massachusetts, clusters of TROs (Dorchester Center and Jamaica Plain) and reported smoking behaviors (Dorchester Center, Roxbury Crossing, Lawrence) were found in economically disadvantaged neighborhoods. Despite the widespread distribution of TROs throughout the communities, participants overwhelmingly visited a relatively small number of TROs in Roxbury and Methuen. In Texas, clusters of TROs (Spring, Jersey Village, Bunker Hill Village, Sugar Land, and Missouri City) were found primarily in Houston, whereas clusters of reported smoking behaviors were concentrated in West University Place, Aldine, Jersey Village, Spring, and Baytown.

Conclusions: Smartphone apps could be used to pair geolocation data with self-reported smoking behavior in order to gain a better understanding of how tobacco product marketing and promotion influence smoking behavior within vulnerable communities. Public health officials could take advantage of smartphone data collection capabilities to implement targeted tobacco control efforts in these strategic locations to reach underserved communities in their built environment.
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http://dx.doi.org/10.2196/17451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381035PMC
July 2020

Building capacity to implement tobacco-free policies in college and university settings with underserved populations.

Tob Prev Cessat 2019 2;5:14. Epub 2019 Apr 2.

Schroeder Institute at Truth Initiative, Washington, DC, United States.

Introduction: This study aimed to facilitate the process of policy adoption and implementation across community colleges and Historically Black Colleges and Universities (HBCUs) to develop, adopt, and implement a 100% smoke- or tobacco-free policy.

Methods: In total, 135 community colleges and HBCUs took part in the program. This multiple-site case study analyzed each institution's online self-reported surveys every 6 months to record progress on each of five core project elements. Data were analyzed in June 2017.

Results: Overall, 77 of 135 institutions adopted a smoke- or tobacco-free policy during the college initiative program that led to a broader public health impact of more than 717000 students and employees protected from the harms of smoking and secondhand smoke. A regression analysis also found that ongoing/completed policy activities and perceived importance of having a 100% smoke- or tobacco-free policy presented greater odds of an institution passing or adopting a policy.

Conclusions: Population-level impact and total number of people reached by this initiative is notable, though moving smoking off campus can have unintended impacts. This suggests policy change should include cessation efforts, policy compliance and policies into the broader community when possible through community partnerships.
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http://dx.doi.org/10.18332/tpc/105677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205066PMC
April 2019

Prescription Opioid Misuse: Examining the Role of Opioid-Related Attitudes among Youth and Young Adults by Sexual Orientation.

Subst Use Misuse 2020 23;55(10):1601-1609. Epub 2020 Apr 23.

Schroeder Institute at Truth Initiative, Washington, DC, USA.

: High prevalence of opioid misuse has been noted among youth and young adults-particularly among those who identify as lesbian/gay or bisexual (LGB). Yet, little is known about the relationship between opioid-related attitudes and misuse among those who identify as LGB. : This study examined the role of opioid-related attitudes (i.e. acceptance of misuse and risk perception) in relation to ever and past 6-month prescription opioid misuse, stratified by sexual orientation. : This study used a nationally representative, probability-based sample of youth and young adults aged 15-34 ( = 12,745; lesbian/gay = 398, bisexual = 857, heterosexual = 11,490). Data were collected online surveys in Spring 2018. Wald chi-square tests assessed differences in ever and past 6-month opioid misuse by sexual orientation identity. Weighted adjusted logistic regression models estimated the influence of opioid-related attitudes (acceptance of misuse and risk perceptions) in relation to ever and past 6-month opioid misuse, controlling for demographic characteristics, other past drug use, and psychosocial variables. : Logistic regression models indicated that attitudes related to the acceptance of opioid misuse was predictive of (a) higher odds of misuse among heterosexual and bisexual individuals and (b) higher odds of past 6-month misuse regardless of sexual orientation. : Prescription opioid misuse among LGB youth and young adults may be addressed by shifting key attitudes surrounding opioids. To help stem this deadly epidemic, prevention efforts should be guided by the unique stressors facing the LGB community and focus on reducing the acceptability of misusing opioids.
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http://dx.doi.org/10.1080/10826084.2020.1753774DOI Listing
June 2021

Early Evidence of an Opioid Education Campaign: A Case Study of Rhode Island.

J Public Health Manag Pract 2020 May/Jun;26(3):252-258

Schroeder Institute at Truth Initiative, Washington, District of Columbia (Drs Rath, Hair, Barton, Kreslake, and Vallone); Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Drs Rath, Hair, and Vallone); Crux Research, Honeoye Falls, New York, New York (Mr Geraci and Ms Palmerini); Office of Governor Gina M. Raimondo, Providence, Rhode Island (Mr Coderre); and Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, New York (Dr Vallone).

Context: The opioid crisis poses a significant burden at a national level, and certain states have seen particularly high rates of misuse, addiction, and overdose. In 2017, Rhode Island reported opioid-related deaths nearly twice the national average.

Objective: To test message efficacy and evaluate the effectiveness of campaign messaging to shift attitudes/beliefs related to opioid misuse in Rhode Island.

Design: In phase 1, near-final versions of 6 advertisements were shown to a sample of the target audience via an online survey portal to assess responses to the messages (N = 1210). Phase 2 of the study employed a pre/posttest design whereby 2 cross-sectional surveys were conducted, first prior to the campaign launch (N = 456) and another survey 6 months later in Rhode Island (N = 433).

Setting: Phase 1 was conducted online using a nationally representative panel, and phase 2 included a convenience sample of participants in Rhode Island recruited to undergo an online survey.

Participants: Eighteen- to 29-year-old members of a nationally representative online panel (phase 1) and 15- to 34-year-olds living in the state of Rhode Island during data collection periods.

Main Outcome Measure(s): Empathy and destigmatization ("someone like me could become addicted..." and "those who are dependent on prescription opioids are victims") and perceived risk of developing dependence on opioids.

Results: In both phases, there was an increase in empathy ("someone") (phase 1: pretest [31%], posttest [42%; z = 5.5, P < .0001] and phase 2 [34% baseline vs 41% follow-up; z = 2.0, P = .04]) and destigmatization ("victims") (phase 1: pretest [54%], posttest [58%; z = 2.2, P = .01] and phase 2 [46% baseline vs 54% follow-up; z = 2.2, P = .03]). There was also an increase in perceived risk: phase 1 (pretest [65%], posttest [75%; z = 5.4, P < .0001]) and phase 2 (66% baseline vs 74% follow-up; z = 2.5, P = .01).

Conclusions: This study demonstrated the potential efficacy of a media campaign to shift young adults' opioid-related attitudes.
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http://dx.doi.org/10.1097/PHH.0000000000001154DOI Listing
April 2021

Validating Self-Reported Ad Recall as a Measure of Exposure to Digital Advertising: An Exploratory Analysis Using Ad Tracking Methodology.

Int J Environ Res Public Health 2020 03 25;17(7). Epub 2020 Mar 25.

Schroeder Institute at Truth Initiative, Washington, DC 20001, USA.

Many mass media campaigns aimed at changing young people's health behavior air on digital platforms rather than on broadcast media (e.g., television), given the intended audience's preference for web-based communication. While research suggests self-reported ad recall correlates with exposure to television advertising, it remains unclear whether self-report measures are correlated with exposure to digital advertising. This study examined the association between an objective measure of digital ad exposure and self-reported recall of digital ads from the truth tobacco prevention campaign. Digital ad tracking methodology was employed to identify members of an online panel (ages 18-34) who had been exposed to ads during their regular web browsing. Demographics of exposed participants were used to develop a matched control group of non-exposed panel members. Members of the Exposed group ( = 458) and matched Control participants ( = 506) were surveyed on recall of truth ads, media use, and demographics. Results indicated that Exposed participants had significantly higher odds of reporting ad recall compared to Control participants. With each additional ad exposure, the odds of self-reporting higher frequency of ad exposure increased by 8% (OR = 1.08, 95% CI = 1.01-1.16). Findings suggest self-reported measures of ad recall are a valid measure of campaign exposure in a digital media environment.
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http://dx.doi.org/10.3390/ijerph17072185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177256PMC
March 2020

Using Aggregate Temporal Variation in Ad Awareness to Assess the Effects of the truth® Campaign on Youth and Young Adult Smoking Behavior.

J Health Commun 2020 03 4;25(3):223-231. Epub 2020 Mar 4.

Schroeder Institute at Truth Initiative, Washington, DC, USA.

Mass media campaigns are one of the most effective population-level interventions for the prevention of tobacco use. However, accurately evaluating the effectiveness of these campaigns presents several challenges, particularly as campaign delivery becomes increasingly fractured across media platforms. There are a number of weaknesses associated with traditional, individual-level measures of campaign exposure in an increasingly socially networked, digital media ecosystem. This study evaluated the national truth® campaign using a novel method to measure campaign exposure through an aggregate weekly exogenous measure of awareness. We generated this exogenous measure from a continuous, cross-sectional tracking survey to predict intentions to smoke and current tobacco use among youth in the United States. Results from multi-level models indicated that weeks with aggregate campaign awareness greater than 65% were associated with lower odds of current tobacco use. We conclude with a discussion of implications and practical considerations for using this method for media campaign evaluation.
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http://dx.doi.org/10.1080/10810730.2020.1733144DOI Listing
March 2020

Perceptions of Use Patterns and Health Consequences Associated With Mentholated Cigarettes Among U.S. Adults.

Health Educ Behav 2020 04 31;47(2):284-292. Epub 2020 Jan 31.

New York University, New York, NY, USA.

Despite declines in overall cigarette smoking in the United States, menthol cigarette smoking prevalence has increased among young adults (18-25 years) and remains constant among older adults (26 years and older). Disparities in menthol cigarette use exist, with higher prevalence among younger adult smokers and among racial/ethnic minority populations. Menthol in cigarettes has been shown to play a role in increasing smoking initiation and making it more difficult to quit smoking. Little research focuses on perceptions of the addictive potential and health consequences of menthol cigarette use. This analysis uses data from a national panel of U.S. adults ( = 1,303) surveyed in 2016. Participants were asked to what extent they agreed with various statements regarding menthol use among demographic and tobacco use subgroups. These data reveal disparities in perceptions of the impact of menthol use, with Black, non-Hispanic, and Hispanic adults and adults with lower income and less education misperceiving the health effects and addiction potential of menthol in cigarettes. Determining how and to what extent population subgroups understand the effect of menthol cigarette use can inform public education strategies and, in turn, policy efforts to ban or restrict menthol cigarette availability.
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http://dx.doi.org/10.1177/1090198119897608DOI Listing
April 2020

PhenX: Environment measures for Tobacco Regulatory Research.

Tob Control 2020 01;29(Suppl 1):s35-s42

Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA.

Objective: A Working Group (WG) of tobacco regulatory science experts identified measures for the tobacco environment domain.

Methods: This article describes the methods by which measures were identified, selected, approved and placed in the PhenX Toolkit.

Findings: The WG identified 20 initial elements relevant to tobacco regulatory science and determined whether they were already in the PhenX Toolkit or whether novel or improved measures existed. In addition to the 10 complementary measures already in the Toolkit, the WG recommended 13 additional measures: aided and confirmed awareness of televised antitobacco advertising, interpersonal communication about tobacco advertising, media use, perceived effectiveness of antitobacco advertising, exposure to smoking on television and in the movies, social norms about tobacco (for adults and for youth), worksite policies, youth cigarette purchase behaviours and experiences, compliance with cigarette packaging and labelling policies, local and state tobacco control public policies, and neighbourhood-level racial/ethnic composition. Supplemental measures included youth social capital and compliance with smoke-free air laws and with point of sale and internet tobacco marketing restrictions. Gaps were identified in the areas of policy environment (public and private), communications environment, community environment and social environment (ie, the norms/acceptability of tobacco use).

Conclusions: Consistent use of these tobacco environment measures will enhance rigor and reproducability of tobacco research.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712634PMC
January 2020

Electronic Cigarette and JUUL Use Among Adolescents and Young Adults.

JAMA Pediatr 2020 03;174(3):277-286

Schroeder Institute, Truth Initiative, Washington, District of Columbia.

Importance: The increasing use rates of electronic cigarettes (e-cigarettes) among young people in the United States have been largely associated with the emergence of high-nicotine-delivery device JUUL. Relevant data are needed to monitor e-cigarette, specifically JUUL, use to help inform intervention efforts.

Objective: To estimate the prevalence, patterns, and factors associated over time with e-cigarette use among adolescents and younger adults in the United States.

Design, Setting, And Participants: Two nationally representative longitudinal samples of adolescents and younger adults aged 15 to 34 years were drawn from the Truth Longitudinal Cohort, a national, probability-based cohort. Participants in this cohort were recruited through address-based sampling, and subsamples were recruited from a probability-based online panel. The present cohort study used data from follow-up online surveys, specifically, wave 7 (N = 14 379; collected from February 15, 2018, to May 25, 2018) and wave 8 (N = 12 114; collected from February 10, 2019, to May 17, 2019). Respondents reported their use of e-cigarettes, JUUL, and combustible tobacco products as well as their harm perceptions, household smoking status, sensation-seeking, friends' e-cigarette use, and demographic information.

Main Outcomes And Measures: The main outcomes were ever and current (past 30 days) JUUL use. χ2 Analyses assessed differences in JUUL use by psychosocial and demographic characteristics. Logistic regression models identified the significant factors associated with wave 8 ever and current JUUL use among wave 7 e-cigarette-naive participants.

Results: A total of 14 379 participants (mean [SD] age, 24.3 [0.09] years; 8142 female [51.0%]) were included in wave 7 and 12 114 (mean [SD] age, 24.5 [0.10] years; 6835 female [50.1%]) in wave 8. JUUL use statistically significantly increased from wave 7 to wave 8 among ever users (6.0% [n = 1105] to 13.5% [2111]; P < .001) and current users (3.3% [680] to 6.1% [993]; P < .001). JUUL use increased among every age group and was highest among those aged 18 to 20 years (23.9% [491] ever users and 12.8% [340] current users) and 21 to 24 years (18.1% [360] ever users and 8.2% [207] current users). Users reported a higher prevalence of frequent use in wave 8 compared with wave 7 (37.6% vs 26.1%; P < .01). Significant factors associated with future JUUL use among e-cigarette-naive participants included younger age, combustible tobacco use, lower harm perceptions, sensation seeking, and friends' e-cigarette use.

Conclusions And Relevance: This study found that the e-cigarette device JUUL appears to be associated with the youth e-cigarette epidemic, attracting new users and facilitating frequent use with their highly addictive nicotine content and appealing flavors. Findings of this study underscore the critical need for increased e-cigarette product regulation at the federal, state, and local levels.
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http://dx.doi.org/10.1001/jamapediatrics.2019.5436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990671PMC
March 2020
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