Publications by authors named "Emma I Brett"

28 Publications

  • Page 1 of 1

Effects of Visual Exposure to IQOS Use on Smoking Urge and Behavior.

Tob Regul Sci 2021 Jan;7(1):31-45

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States.

Objectives: In this study, we examined whether visual exposure to the heated tobacco product (HTP) IQOS, which was authorized for sale by the US Food and Drug Administration in 2019, acts as a cue to increase cigarette craving and smoking behavior among smokers.

Methods: Young adult smokers (N = 105) were randomly assigned to view a video depicting use of either IQOS or bottled water. Main outcomes were changes in cigarette and e-cigarette desire and latency to smoke between the groups. We also examined participants' attitudes about the actors using IQOS and drinking water in the videos.

Results: Exposure to the use of IQOS acutely increased observers' ratings of smoking urge and desire for a cigarette and an e-cigarette. The IQOS cue, compared with the water cue, also produced a marginally significant shorter latency to smoke. Participants perceived actors as less likeable and friendly when using IQOS than when drinking water.

Conclusions: Results showed that exposure to IQOS produced smoking urge and behavior in young adult smokers, implicating IQOS use as a smoking and vaping cue. As HTPs gain popularity, product impact on passive observers should be included in their risk-benefit profile.
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http://dx.doi.org/10.18001/trs.7.1.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318301PMC
January 2021

Electronic nicotine delivery systems (ENDS) cue reactivity in dual users: A combined analysis.

Drug Alcohol Depend 2021 Jul 21;227:108909. Epub 2021 Jul 21.

The University of Illinois at Chicago, Department of Visual Sciences and Opthalmology, Chicago, IL, 60607, United States.

Background: Cigarette smokers report increases in smoking urge in response to exposure to electronic nicotine delivery systems (ENDS) and dual users, i.e. smokers who also vape ENDS, may exhibit greater cue reactivity than exclusive smokers. The current investigation examined reactivity to a variety of ENDS cues across a large sample of cigarette smokers and dual ENDS users.

Methods: Young adult smokers (N = 345; >5 cigarettes per day) were recruited between 2013-2019 for participation in a series of within-subjects laboratory-based studies. Participants completed surveys before and after exposure to a confederate-delivered control cue (water) and an active cue, including cigarette or ENDS cues ranging from first generation "cigalikes" to a fourth generation "pod-mod". Main outcomes were post-cue changes in desire for combustible cigarettes and e-cigarettes, and smoking behavior as determined by the smoking latency portion of the Smoking Lapse Paradigm after cue exposure.

Results: Relative to smokers who do not use ENDS, dual users demonstrated higher baseline desire for ENDS and greater ENDS cue reactivity (across product types) in terms of post-cue increases in smoking urge and shorter latency to smoking choice. In contrast, reactivity to the cigarette cue was similar across groups.

Conclusions: Dual users show heightened ENDS cue reactivity on smoking urge and behavior relative to never users of ENDS, regardless of the type of ENDS cue. Given their reactivity to both cigarette and ENDS cues, it may be difficult for dual users to transition to exclusive vaping or quit tobacco product use altogether.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108909DOI Listing
July 2021

Displacement imposition scale assesses reactions of cigarette and e-cigarette users impacted by a campus-wide smoking ban.

J Am Coll Health 2021 Jul 9:1-7. Epub 2021 Jul 9.

Department of Psychology, Oklahoma State University, Stillwater, OK.

Objective: The present study developed a measure assessing the emotional responses, "Displacement Imposition," of cigarette and e-cigarette users on a college campus with a smoking/vaping ban. It also examined the relationship between and readiness to quit smoking/vaping, and how this relationship differed between cigarette and e-cigarette users.

Participants: Participants (N = 297) were from a large, Midwestern university.

Methods: Participants completed online questionnaires assessing demographics, cigarette and e-cigarette use, , and readiness to quit.

Results: All six items loaded onto a single factor. A significant interaction emerged between and product use in predicting readiness to quit. At high levels of , cigarette users were less ready to quit than e-cigarette users.

Conclusions: Findings suggest restrictions imposed on cigarette and e-cigarette users were associated with reduced readiness to quit. Findings inform tobacco control policies as tobacco denormalization may increase the burden placed on tobacco users.
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http://dx.doi.org/10.1080/07448481.2021.1942003DOI Listing
July 2021

Changes in dependence, withdrawal, and craving among adult smokers who switch to nicotine salt pod-based e-cigarettes.

Addiction 2021 Jun 9. Epub 2021 Jun 9.

Department of Psychology, California State University San Marcos.

Background And Aims: For electronic cigarettes (e-cigarettes) to be a viable substitute for combustible cigarettes, it is likely that they must be rewarding enough for regular use, indicated by factors such as craving and dependence, important aspects of reinforcement. This study aimed to understand short-term changes in measures of nicotine dependence between groups differing by use trajectory in a switching trial, and within group changes of these measures.

Design: Secondary data analysis of one arm of an e-cigarette randomized clinical trial.

Setting: San Diego, California and Kansas City, Missouri, United States.

Participants: 114 African American (n = 60) and Latinx (n = 54) smokers (58.8% male) attempting to switch to nicotine salt pod system (NSPS) e-cigarettes in a 6-week trial.

Measurements: At week 6, participants were classified by use trajectory: exclusive smokers (n = 16), exclusive e-cigarette (n = 32), or dual users (n = 66). E-cigarette, cigarette, and total nicotine dependence (cigarette + e-cigarette), use patterns, cigarette craving and nicotine withdrawal, and cotinine were assessed at baseline and week 6 using standard measures.

Findings: In between group comparisons, exclusive e-cigarette and dual users showed greater reductions in cigarette dependence (e-cigarette: -32.38, 95% CI = -37.7,-27.1; dual: -18.48, 95% CI = -22.2,-14.7), withdrawal (e-cigarette: -6.25, 95% CI = -8.52,-3.98; dual: -3.18, 95% CI = -5.02,-1.34), craving (e-cigarette: -11.44, 95% CI = -14.2,8.7; dual: -9.59, 95% CI = -11.6,-7.59), and cigarettes per day (CPD; e-cigarette: -11.19, 95% CI = -13.1,-9.27; dual: -9.39, 95% CI = -11.3, -7.52) compared with exclusive smokers. In within group analyses, e-cigarette and dual users showed reductions in craving and withdrawal from baseline to week 6. Exclusive e-cigarette and dual users, maintained cotinine levels (all Ps > 0.05) and showed reductions in CPD and cigarette dependence (all Ps < 0.01). Findings were inconclusive regarding changes in total nicotine dependence from baseline to week 6 among exclusive e-cigarette users (P = 0.123). Dual users showed increased total nicotine dependence (P < 0.001) and smokers showed decreased total dependence (P = 0.004).

Conclusions: Smokers who switch to nicotine salt pod system e-cigarettes maintain their nicotine levels and transfer their dependence, suggesting that nicotine salt pod system e-cigarettes have a similar reinforcement potential to cigarettes and facilitate switching.
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http://dx.doi.org/10.1111/add.15597DOI Listing
June 2021

Effects of a brief motivational smoking intervention in non-treatment seeking disadvantaged Black smokers.

J Consult Clin Psychol 2021 Apr 11;89(4):241-250. Epub 2021 Mar 11.

Department of Psychiatry and Behavioral Neuroscience.

While the U.S. adult smoking rate has declined, Black smokers disproportionately face more barriers to accessing brief effective tobacco cessation treatments compared with other racial groups. This study developed and tested the effects of a novel, evidence-based, brief smoking intervention culturally targeted for disadvantaged Black smokers (ClinicalTrials.gov ID: NCT04460417). In this randomized controlled trial, primarily low-income Black non-treatment-seeking smokers ( = 204, 51% female) were randomized to enhanced care (EC) or treatment as usual (TAU). The EC group received a 30-min session with personal feedback on smoking, education on health outcomes and tobacco advertising targeting Black smokers, and nicotine replacement therapy (NRT) starter kits. TAU included provision of self-help materials. Primary outcome was motivation to change smoking behavior, and secondary outcomes included NRT knowledge and use, quit attempts, and number of cigarettes smoked per day. Data were collected at baseline, 1- and 6-month follow-ups. Compared with TAU, EC increased motivation to change ( = .02), accuracy in NRT knowledge, ( < .001), NRT use ( = .01), and likelihood of making a serious quit attempt as well as reduced cigarettes smoked per day ( < .01) through 6-month follow-up. A brief motivational intervention for Black non-treatment-seeking smokers increased motivation to change smoking and resulted in improvements in NRT knowledge, use, and quit-relevant behaviors. Findings support cultural-targeting and provision of NRT to enhance motivation in Black smokers to reduce cultural and institutional barriers to tobacco cessation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000629DOI Listing
April 2021

Influencing college students' normative perceptions of protective behavioral strategies: A pilot randomized trial.

Addict Behav 2020 05 17;104:106256. Epub 2019 Dec 17.

Department of Psychology, Oklahoma State University, Stillwater, OK, United States. Electronic address:

Introduction: Personalized feedback interventions (PFIs) are associated with small but reliable decreases in alcohol consumption among college students. While they often include information regarding protective behavioral strategies (PBS), PFIs do not typically include feedback aimed to modify normative perceptions of PBS. This study aimed to enhance the efficacy of existing PFIs among college students by incorporating normative feedback on participants' use of PBS.

Methods: Students enrolled in undergraduate courses (N = 268) completed baseline and 1-month follow-up assessments of past-month use of PBS, normative perceptions of PBS use, alcohol consumption, and alcohol-related consequences. Participants were randomized to one of three conditions: typical feedback on PBS (typical strategies PFI), descriptive normative feedback on PBS (strategy norms PFI), or assessment-only control (AOC). Participants in the typical strategies PFI and strategy norms PFI conditions received web-based personalized feedback profiles.

Results: Compared to AOC, both the strategy norms PFI and typical strategies PFI were effective in correcting participants' perceptions of other students' engagement in PBS (p = .01) but did not differ significantly from one another. No statistically significant differences were observed between conditions in terms of actual PBS use, alcohol consumption, or alcohol-related consequences at 1-month follow-up (p > .05).

Discussion: The strategy norms and typical strategies PFIs were both successful in increasing normative perceptions of PBS use, indicating that general (rather than normative) feedback regarding PBS use may be sufficient for changing perceptions of PBS use.
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http://dx.doi.org/10.1016/j.addbeh.2019.106256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286103PMC
May 2020

Electronic cigarette use and sleep health in young adults.

J Sleep Res 2020 06 4;29(3):e12902. Epub 2019 Sep 4.

Department of Psychology, Oklahoma State University, Stillwater, OK, USA.

Poor sleep health is associated with numerous health concerns, and sleep problems are exacerbated by cigarette smoking. Although rates of traditional tobacco use are declining, rates of electronic cigarette (e-cigarette) use are comparatively high and growing. Given that nicotine is a primary mechanism by which smoking negatively impacts sleep health, e-cigarette use may also be linked to poor sleep health; however, no research has investigated this association. Participants were 1,664 college students, 40.9% of whom reported ever trying or currently using an e-cigarette. Questionnaires assessed demographic information, sleep health and e-cigarette use status and patterns. All measures were completed remotely via a secure online survey. Analysis of covariance was used to compare the sleep health of daily/non-daily e-cigarette users to (a) non-users and (b) users of combustible cigarettes. Gender and drinks per week were included as covariates in analyses. Current combustible and e-cigarette users reported significantly more sleep difficulties than never users. Users of e-cigarettes reported greater use of sleep medication than combustible cigarette users. Similar to combustible cigarette smoking, e-cigarette use (vs. non-use) was associated with worse sleep health, even among non-daily e-cigarette users. These findings may indicate a need for assessment of and education on the role of e-cigarette use in sleep health among individuals who report experimentation with or current use of e-cigarettes. Future research should examine these relationships prospectively.
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http://dx.doi.org/10.1111/jsr.12902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299171PMC
June 2020

JUUL in school: JUUL electronic cigarette use patterns, reasons for use, and social normative perceptions among college student ever users.

Addict Behav 2019 12 9;99:106047. Epub 2019 Jul 9.

Ohio State University, Columbus, Ohio, USA; James Cancer Hospital, Columbus, Ohio, USA. Electronic address:

Background: JUUL electronic cigarettes have surged in popularity since their emergence on the market in 2015. JUUL is slim and simple in design and is capable of delivering cigarette-like levels of nicotine. However, little research has examined JUUL use patterns, reasons for use, and normative perceptions of JUUL among young adults.

Methods: Participants were college students (N = 243) who reported ever using a JUUL electronic cigarette. Eligible participants completed a survey assessing JUUL use patterns, reasons for JUUL use, and normative perceptions of JUUL.

Results: Most participants reported using JUUL once or twice (47.7%) and almost one-third reported using JUUL daily or monthly (29.6%). Overall, participants reported a low level of nicotine dependence (M = 0.93, SD = 2.04). Cool Mint was the most preferred flavor (35.8%) followed by Mango (12.0%). The top reasons for use were because "friends were using it" (27.0%) and "curiosity" (19.4%). Nearly half (49.8%) of participants reported that they would tell all five of their five closest friends that they use JUUL. Only 10.7% reported a belief that none of their friends would approve of their JUUL use.

Conclusions: The high percentage of daily and monthly JUUL users coupled with the relatively high rates of perceived acceptability of use indicates the possibility of high uptake among college students. Findings also suggest college students perceive JUUL as highly acceptable and that their friend's use and curiosity were primary motivators of their initial use, indicating the importance of peer influence in college student JUUL use.
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http://dx.doi.org/10.1016/j.addbeh.2019.106047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7153300PMC
December 2019

Temporal Estimations and Subjective Evaluations of Alcohol Consequences.

Am J Health Behav 2019 09;43(5):1006-1015

Oklahoma State University, Department of Psychology, Stillwater, OK.

College student alcohol interventions utilizing public health messaging describe consequences that are delayed and significantly negative, a strategy shown to be ineffective. It is possible that messaging related to immediate, likely, and less negative consequences may be better at reducing problematic drinking. Although research has investigated perceptions of subjective evaluations, no studies have included perceptions of likelihood of occurrence and temporal estimations of alcohol-related consequences. In the current study, we measured perceptions of consequences in terms of likelihood of occurrence, temporal estimations, and subjective evaluations. Undergraduate students (N = 308) from a large, Midwestern university completed an online survey assessing alcohol use patterns and perceptions of consequences (ie, likelihood of occurrence, temporal estimations, and subjective evaluations). Results: Students perceived failure to graduate and drunk driving to be the least likely, most negative, and most delayed consequences; vomiting and hangovers were the most likely, least negative, and most immediate consequences. Independent t-tests revealed statistically significant differences between high- and low-risk drinkers. Conclusions: Students perceived differences in consequences on temporal estimation, likelihood of occurrence, and subjective evaluations. Future studies should examine how these perceptions affect subsequent alcohol use.
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http://dx.doi.org/10.5993/AJHB.43.5.11DOI Listing
September 2019

JUUL electronic cigarette use patterns, other tobacco product use, and reasons for use among ever users: Results from a convenience sample.

Addict Behav 2019 08 18;95:178-183. Epub 2019 Feb 18.

Oklahoma Tobacco Research Center, Oklahoma City, OK, United States of America; University of Oklahoma Health Science Center, Department of Pediatrics, Oklahoma City, OK, United States of America. Electronic address:

Introduction: JUUL, an e-cigarette from PAX Labs, has captured 70% of the e-cigarette market. The current study examines JUUL use patterns and reasons for initiation in a large convenience sample of U.S. adults.

Methods: Respondents were 979 U.S. adults registered on Amazon Mechanical Turk (MTurk) who reported ever using JUUL. Items included frequency/quantity of JUUL use, reasons for trying JUUL, flavor preferences, and use of other tobacco products.

Results: The majority of participants reported only trying JUUL once or twice (59.5%), 29.2% reported regular nondaily use and 10.3% reported daily use. The average quantity of JUUL pod use was low in the overall sample (4 pods per month). Daily users reported using ~10 pods per month and engaging in 4-9 separate vaping sessions per day. The most frequently reported reasons for JUUL use were because friends were using it (26.5%), curiosity (20.5%), and similarity to a cigarette (7.7%). Approximately 26% of current JUUL users reported current exclusive JUUL use, while 56% reported using JUUL and another e-cigarette. Of the entire sample, 37.1% were former smokers. Of those, 14.9% were daily JUUL users, 21.4% were nondaily JUUL users, and 63.8% were JUUL triers.

Conclusions: This is the first study to examine patterns and reasons for use of the most popular e-cigarette on the market. In this convenience sample, nearly 40% of those who ever tried JUUL reported current daily or daily use. JUUL use may be associated with limited puffing patterns compared to earlier generation e-cigarettes. Research is needed to investigate if JUUL puffing patterns result in decreased exposure to potentially harmful non-nicotine e-liquid constituents compared to other e-cigarettes.
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http://dx.doi.org/10.1016/j.addbeh.2019.02.011DOI Listing
August 2019

Concurrent Alcohol Use and Waterpipe Tobacco Smoking: Smoking Topography, Toxicant Exposure, and Abuse Liability.

Nicotine Tob Res 2020 02;22(2):280-287

Oklahoma Tobacco Research Center, Oklahoma City, OK.

Introduction: Relative to non-waterpipe (WP) smokers, WP smokers are more than twice as likely to use alcohol and frequently consume alcohol before or during smoking sessions. Co-use of alcohol and WP may result in greater toxicant exposure compared to WP smoking alone. To date, no study systematically has investigated the impact of acute alcohol intoxication on WP smoking topography, exposure to tobacco-related toxicants, or abuse liability.

Methods: Dyads of current WP smokers and drinkers (N = 42; age = 21-32 years) completed two in-laboratory ad libitum smoking sessions (≤2 hours) following 12-hour nicotine abstinence in a double-blind, randomized crossover design in which they consumed a placebo versus active drink (sustained breath alcohol concentration = .08). Exhaled carbon monoxide (eCO) and plasma nicotine concentration were assessed. Questionnaires assessed smoking experience and smoking urge. Smoking topography was measured continuously throughout each smoking session.

Results: The alcohol session was associated with increased inhaled volume, flow rate, and WP session duration compared to placebo. Compared to placebo, participants reported a more positive overall smoking experience following the alcohol session and greater smoking urges pre- and post-smoking session. Although both sessions resulted in significant increases in eCO and plasma nicotine, no significant differences emerged in eCO or nicotine exposure between the active and placebo sessions.

Conclusions: Co-use of alcohol and WP may contribute to the maintenance of WP smoking through enhanced smoking experiences, increased urge to smoke, and significant exposure to addictive nicotine. Regulations may be necessary to limit the sale of alcohol in WP smoking lounges and reduce exposure to secondhand smoke.

Implications: The findings suggest co-use of alcohol and WP tobacco likely maintain WP use and dependence by enhancing the smoking experience and increasing urges to smoke. These findings have implications for regulations aimed at limiting co-use of alcohol and WP tobacco in WP lounges and limiting exposure to secondhand smoke.

Clinical Trials Registration: NCT03096860.
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http://dx.doi.org/10.1093/ntr/ntz032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297088PMC
February 2020

Electronic cigarette and combustible cigarette use following a campus-wide ban: Prevalence of use and harm perceptions.

J Am Coll Health 2020 May-Jun;68(4):332-335. Epub 2019 Jan 25.

Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.

The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban ( = 792) and in fall 2014 ( = 310), 2015 ( = 208), and 2016 ( = 417). E-cigarette use increased in the years following the ban ( = .01) while combustible cigarette use decreased from 2013 to 2016 ( = .02). Men were more likely than women to use both products ( < .05). Students' perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban ( > .05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.
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http://dx.doi.org/10.1080/07448481.2018.1551803DOI Listing
April 2021

Electronic cigarette and combustible cigarette use following a campus-wide ban: Prevalence of use and harm perceptions.

J Am Coll Health 2020 May-Jun;68(4):332-335. Epub 2019 Jan 25.

Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.

The current study examined changes in prevalence of e-cigarette use and perceptions of the harmfulness of e-cigarette and combustible cigarettes following a campus-wide tobacco ban. Undergraduate students completed surveys of tobacco use and perceived product harmfulness. Four samples were collected: in 2013 prior to the ban ( = 792) and in fall 2014 ( = 310), 2015 ( = 208), and 2016 ( = 417). E-cigarette use increased in the years following the ban ( = .01) while combustible cigarette use decreased from 2013 to 2016 ( = .02). Men were more likely than women to use both products ( < .05). Students' perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban ( > .05). This study is the first to examine the impact of including e-cigarettes in tobacco free policies. Combustible cigarette use declined, but e-cigarette use increased in the years following the e-cigarette ban. Prospective research is needed to understand the long-term impacts of e-cigarette bans.
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http://dx.doi.org/10.1080/07448481.2018.1551803DOI Listing
April 2021

A Meta-analysis of Brief Personalized Feedback Interventions for Problematic Gambling.

J Gambl Stud 2019 Jun;35(2):447-464

Institute of Gambling Education and Research, The University of Memphis, Room 202 Psychology Building, 400 Innovation Drive, Memphis, TN, 38152-6400, USA.

Personal Feedback Interventions (PFIs) have been widely used to reduce the amount of time and money individuals spend on gambling. A central component of these interventions is personalized information about an individual's gambling behavior, often in comparison to others' gambling. The purpose of the present review and meta-analysis was to evaluate these interventions in terms of content, mode of delivery, target sample, and efficacy. Sixteen interventions from 11 studies were reviewed. We found a small, statistically significant effect in favor of PFIs versus control (d = 0.20, 95% CI 0.12, 0.27). Six moderators of intervention efficacy were explored. These interventions appeared to be most efficacious when used in populations of greater gambling severity, when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing. Factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity. Efficacy did not vary as a function of college or community samples. PFIs are a low cost, easily disseminated intervention that can be used as a harm-reduction strategy. However, more substantial effects may be attained if used as part of a larger course of therapy.
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http://dx.doi.org/10.1007/s10899-018-09818-9DOI Listing
June 2019

A content analysis of JUUL discussions on social media: Using Reddit to understand patterns and perceptions of JUUL use.

Drug Alcohol Depend 2019 01 13;194:358-362. Epub 2018 Nov 13.

Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA. Electronic address:

Background: JUUL, an electronic cigarette, is estimated to occupy 50% of the e-cigarette market and appears to be particularly common among youth. However, there is little research on perceptions of JUUL. The aim of the current study was to examine posts on Reddit specific to JUUL and youth to better understand the context and perceptions of JUUL use.

Methods: This content analysis utilized social media discussions posted between January 2015-May 2017. Public posts on Reddit, a social media platform, were gathered and coded. Posters of discussions relevant to both JUUL and youth were included for analysis.

Results: 364 posts were included for quantitative content analysis. Posts were mixed in terms of polarity with many (41.1%) including positive and negative language regarding JUUL. In terms of polarity of youth use, 60% of posts showed negative perceptions of youth use. Among posts by youth, only 37% showed negative perceptions of youth use. Posts included a variety of reasons for using JUUL with the most frequent reason being the popularity of JUUL (34.2%) followed by using it to quit smoking (23.3%) and to feel a buzz (20.2%). Age restrictions were the most common barrier to use.

Conclusions: Posters generally had a nuanced perception of JUUL and identified both positive and negative aspects. Interestingly, while primary reasons for youth use indicate the strong influence of social norms, barriers to use suggest that public health interventions such as age restrictions may curb youth use. Findings can inform prevention efforts and important factors for JUUL initiation.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.10.014DOI Listing
January 2019

Polytobacco use and risk perceptions among young adults: The potential role of habituation to risk.

Addict Behav 2019 03 8;90:278-284. Epub 2018 Nov 8.

Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, United States; Oklahoma University Health Sciences Center, Department of General and Community Pediatrics, 1200 N. Phillips Ave., Suite 12400, Oklahoma City, OK 73104, United States. Electronic address:

Introduction: Polytobacco use and experimentation is common among young adults. Additional research is needed to determine how these patterns of use impact perceptions of tobacco-related harm and risk. The current study examined whether a relationship exists between an increased number of tobacco products used and decreases in perceptions of harmfulness and health risk.

Method: Participants (N = 792) completed a survey assessing current/lifetime tobacco use, perceived absolute harmfulness of tobacco/nicotine products and perceived health risk of smoking. For some analyses, participants were grouped by polytobacco use status.

Results: Among participants who ever tried a tobacco product, a greater number of products tried was associated with lower perceptions of harm (all p < .05). For e-cigarettes and hookah, nonusers rated tobacco products as more harmful compared to single product, dual, and poly users (all p < .05). Number of products tried predicted perceived harmfulness above and beyond demographic characteristics and polytobacco use status across all products. Similarly, number of products tried predicted perceived health risk above and beyond demographic characteristics and polytobacco use status for both lung cancer and heart disease risk.

Discussion: Trying a greater number of tobacco products is associated with lower perceived harmfulness of tobacco products. Prospective studies are needed to determine if experimentation with more tobacco products leads to reductions in perceived risk of tobacco use and subsequent sustained use of tobacco.
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http://dx.doi.org/10.1016/j.addbeh.2018.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049086PMC
March 2019

Childhood adversity and adult health-risk behaviors: Examining the roles of emotion dysregulation and urgency.

Child Abuse Negl 2018 08 4;82:92-101. Epub 2018 Jun 4.

Department of Psychology, Oklahoma State University, Stillwater, OK, USA.

Adverse childhood experiences (ACEs) are important public health concerns, with links to higher prevalence rates of both health-risk behaviors and physical health difficulties in adulthood. Research has demonstrated an association between early adversity and long-term health-risk behavior development. The current study assessed the role of emotion dysregulation and facets of impulsivity as potential mediators in the relation between ACEs and general health-risk behaviors, including alcohol-related consequences and risky sexual behavior. College students (N = 668) completed online questionnaires that assessed history of ACEs, emotion regulation difficulties, impulsivity under extreme affect, and current engagement in health-risk behaviors. Emotion dysregulation and impulsivity under extreme positive emotion, but not negative emotion, demonstrated a significant serial mediation between ACEs and alcohol-related consequences. Results also suggest that emotion dysregulation mediates the relation between early adversity and all three outcomes (i.e., overall engagement in maladaptive behavior, alcohol-related consequences, and risky sexual behavior). Impulsivity under positive or negative affect did not demonstrate a mediation effect on the three outcomes. Results of this study highlight the importance of assessing for emotion regulation skills when working with young adults with histories of adversity.
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http://dx.doi.org/10.1016/j.chiabu.2018.05.027DOI Listing
August 2018

Mindfulness as a mediator of the association between adverse childhood experiences and alcohol use and consequences.

Addict Behav 2018 09 4;84:92-98. Epub 2018 Apr 4.

Department of Psychology, Oklahoma State University, Stillwater, OK, USA. Electronic address:

One-third of college students report past-year heavy episodic drinking, making college student alcohol use an important area for continued research. Research has consistently linked early experiences of adversity to problematic substance use in adolescence and adulthood. Given the negative health consequences associated with heavy episodic drinking, it is imperative to identify mechanisms that contribute to this relation. Low levels of mindfulness have been linked to early adversity as well as impulsivity and alcohol use, therefore, the current study aims to examine the mediating role of mindfulness in the relation between early adversity and current alcohol use and consequences. Undergraduate students (N = 385) at a Midwestern university completed an online questionnaire assessing experiences of childhood adversity, trait mindfulness, and current alcohol use and related consequences. Results indicated that increased adverse experiences and lower levels of mindfulness predicted both increased alcohol consumption and consequences (ps < 0.025), with mindfulness mediating the relationships. Mindfulness is a predictor of alcohol outcomes and appears to mediate the relation between early adversity and alcohol use and consequences. Findings suggest that students with a history of adversity are more likely to exhibit lower levels of mindfulness, which may lead to an increase in alcohol consumption and consequences in early adulthood. Targeted alcohol intervention efforts that incorporate mindfulness skills may be particularly beneficial for those who have experienced early adversity.
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http://dx.doi.org/10.1016/j.addbeh.2018.04.002DOI Listing
September 2018

Improving adoption and acceptability of digital health interventions for HIV disease management: a qualitative study.

Transl Behav Med 2018 03;8(2):268-279

Department of Psychology, Oklahoma State University, Stillwater, OK, USA.

Disease management remains a challenge for many people living with HIV (PLWH). Digital health interventions (DHIs) may assist with overcoming these challenges and reducing burdens on clinical staff; however, there is limited data regarding methods to improve uptake and acceptability of DHIs among PLWH. This qualitative study aimed to assess patient and provider perspectives on the use of DHIs and strategies to promote uptake among PLWH. Eight focus groups with patients (k = 5 groups; n = 24) and providers (k = 3 groups; n = 12) were conducted May through October of 2014. Focus groups (~90 min) followed a semi-structured interview guide. Data were analyzed using thematic analysis on three main themes: (a) perspectives towards the adoption and use of DHIs for HIV management; (b) perceptions of barriers and facilitators to patient usage; and (c) preferences regarding content, structure, and delivery. Analyses highlighted barriers and facilitators to DHI adoption. Patients and providers agreed that DHIs feel "impersonal" and "lack empathy," may be more effective for certain subpopulations, should be administered in the clinic setting, and should use multimodal delivery methods. Emergent themes among the providers included development of DHIs for providers as the target market and the need for culturally adapted DHIs for patient subpopulations. DHIs have potential to improve HIV management and health outcomes. DHIs should be developed in conjunction with anticipated consumers, including patients, providers, and other key stakeholders. DHIs tailored for specific HIV subpopulations are needed. Future studies should evaluate dissemination methods and marketing strategies to promote uptake.
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http://dx.doi.org/10.1093/tbm/ibx025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257012PMC
March 2018

The impact of a brief cessation induction intervention for waterpipe tobacco smoking: A pilot randomized clinical trial.

Addict Behav 2018 03 28;78:94-100. Epub 2017 Oct 28.

Oklahoma Tobacco Research Center, Oklahoma City, OK, USA; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address:

Background: Waterpipe (WP) tobacco smoking delivers many of the same harmful toxicants as cigarette smoking and is on the rise in the US. This study evaluated the feasibility and efficacy of a brief personalized feedback intervention in affecting changes in WP smoking among current WP smokers.

Methods: Participants (N=109) were recruited as they entered WP lounges and completed a questionnaire and exhaled carbon monoxide (eCO) testing before entering the WP lounge. Participants were cluster-randomized to assessment-only control (AOC) or intervention conditions. The intervention condition received health risk information and personalized feedback on pre- and post-WP session eCO levels. Participants completed a survey at the end of the WP session and at 3-month follow-up.

Results: Compared to control, the intervention was effective in increasing knowledge of WP-related harms, correcting risk perceptions, increasing importance of quitting WP smoking, and increasing confidence in ability to quit WP smoking at post-WP session (p<0.05). Differences were maintained for knowledge of WP-related harms, risk perceptions, and commitment to quitting WP at 3-month follow-up; however, no significant difference (p>0.05) was observed in WP smoking (i.e., days smoked and number of WPs smoked) at 3-month follow-up between the intervention (M=3.97days, SD=9.83; M=6.45 bowls, SD=19.60) and control conditions (M=3.32days, SD=5.24; M=3.49 bowls, SD=5.10).

Conclusions: The current research supports the use of personalized feedback as a useful intervention method to increase commitment to quit WP, but suggests more intensive interventions may be necessary to achieve WP cessation.
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http://dx.doi.org/10.1016/j.addbeh.2017.10.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801765PMC
March 2018

Descriptive and injunctive norms of waterpipe smoking among college students.

Addict Behav 2018 Feb 18;77:59-62. Epub 2017 Sep 18.

Oklahoma Tobacco Research Center, Oklahoma City, OK, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address:

Introduction: Smoking tobacco via a waterpipe (WP) is on the rise, particularly among college students. One reason for this may be normative perceptions of WP tobacco smoking (WTS) among this population. The current study examined the perceived and actual descriptive and injunctive norms of WTS among a college student sample.

Methods: Participants were 894 college students enrolled at a large, Midwestern university. Participants completed measures of WTS frequency and quantity and perceived/actual descriptive and injunctive norms of WTS.

Results: Over one-third of the sample reported ever trying WTS, while only 2% reported current (past month) use. When comparing ever and never WP smokers, ever smokers reported greater perceived peer approval of WTS. Both males and females overestimated WTS frequency of same-sex students at their university.

Discussion: The current study is one of the first to investigate descriptive and injunctive norms of WTS among college students. Students who report WTS are more likely to overestimate descriptive norms of WTS among their peers, suggesting corrective normative feedback regarding actual use by peers may be an important target for WTS intervention among college students. Future research should investigate the temporal association between normative perceptions and WTS behaviors among college students.
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http://dx.doi.org/10.1016/j.addbeh.2017.09.006DOI Listing
February 2018

Trait mindfulness and protective strategies for alcohol use: Implications for college student drinking.

Addict Behav 2017 10 8;73:16-21. Epub 2017 Apr 8.

Department of Psychology, Oklahoma State University, Stillwater, OK, United States.

Introduction: The use of Protective Behavioral Strategies (PBS) has been strongly linked with decreased experience of alcohol-related consequences, making them a potential target for intervention. Additionally, mindfulness is associated with decreased experience of alcohol-related consequences. The purpose of the current study was to evaluate a model of PBS as a mediator of the effect of mindfulness on alcohol-related consequences. Additionally, mindfulness as a moderator of the relationship between PBS and alcohol use and consequences was examined.

Methods: College students (N=239) at a large South Central university completed self-report measures of demographics, alcohol use and consequences, use of PBS, and trait mindfulness.

Results: Results indicated that both higher levels of mindfulness and using more PBS predicted decreased alcohol-related consequences and consumption, with PBS mediating both relationships (p<0.01). Those with higher levels of mindfulness were more likely to use PBS, with individuals using more PBS experiencing fewer alcohol-related consequences and consuming fewer drinks per week. Mindfulness moderated the relationship between PBS and consequences, with a significantly stronger negative relationship for those with lower levels of mindfulness.

Conclusions: Individuals who are higher in trait mindfulness are more likely to use PBS, which leads to a decrease in the experience of alcohol-related consequences. Furthermore, for individuals lower in mindfulness, low PBS use may lead to increased experience of alcohol consequences. Interventions that incorporate PBS may be most beneficial for students who are low in mindfulness and unlikely to engage in drinking control strategies.
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http://dx.doi.org/10.1016/j.addbeh.2017.04.011DOI Listing
October 2017

Comparison of a preferred versus non-preferred waterpipe tobacco flavour: subjective experience, smoking behaviour and toxicant exposure.

Tob Control 2018 05 5;27(3):319-324. Epub 2017 Apr 5.

Oklahoma Tobacco Research Center, Oklahoma City, Oklahoma, USA.

Introduction: One possible reason for the rapid proliferation of waterpipe (WP) smoking is the pervasive use of flavoured WP tobacco. To begin to understand the impact of WP tobacco flavours, the current study examined the impact of a preferred WP tobacco flavour compared with a non-preferred tobacco flavoured control on user's smoking behaviour, toxicant exposure and subjective smoking experience.

Method: Thirty-six current WP smokers completed two, 45-minute ad libitum smoking sessions (preferred flavour vs non-preferred tobacco flavour control) in a randomised cross-over design. Participants completed survey questionnaires assessing subjective smoking experience, exhaled carbon monoxide (eCO) testing, and provided blood samples for monitoring plasma nicotine. WP smoking topography was measured continuously throughout the smoking session.

Results: While participants reported an enhanced subjective smoking experience including greater interest in continued use, greater pleasure derived from smoking, increased liking and enjoyment, and willingness to continue use after smoking their preferred WP tobacco flavour (p values <0.05), no significant differences were observed in nicotine and carbon monoxide boost between flavour preparations. Greater average puff volume (p=0.018) was observed during the non-preferred flavour session. While not significant, measures of flow rate, interpuff interval (IPI), and total number of puffs were trending towards significance (p values <0.10), with decreased IPI and greater total number of puffs during the preferred flavour session.

Discussion: The current study is the first to examine flavours in WP smoking by measuring preferred versus control preparations to understand the impact on subjective experience, smoking behaviour and toxicant exposure. The pattern of results suggests that even this relatively minor manipulation resulted in significant changes in subjective experience. These results indicate a possible need for regulations restricting flavours in WP tobacco as with combustible cigarettes.
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http://dx.doi.org/10.1136/tobaccocontrol-2016-053344DOI Listing
May 2018

Subjective evaluations of alcohol-related consequences among college students: Experience with consequences matters.

J Am Coll Health 2017 May-Jun;65(4):243-249. Epub 2016 Dec 23.

a Department of Psychology , Oklahoma State University , Stillwater , OK , USA.

Objective: Research suggests college students rate some alcohol-related consequences less negatively than others, yet it is unclear how or when these differences in perception develop. The current study compared college students' subjective evaluations of alcohol-related consequences that they had and had not experienced in order to test the hypothesis that students become desensitized to the consequences they experience.

Participants: Participants were 269 undergraduate students enrolled at a large, public, Midwestern university.

Methods: Participants completed measures of drinking behaviors, consequences experienced, and subjective evaluations of consequences via an online survey.

Results: Participants rated the consequences they had personally experienced more positively than those they had not experienced. Similarly, individuals who reported experiencing consequences rated them as significantly more positive than those who had not experienced the same consequences.

Conclusions: Experience with consequences is associated with more positive evaluations of those consequences. Therefore, it may be important to consider individuals' experiences with, and evaluations of, alcohol-related consequences in college student drinking interventions.
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http://dx.doi.org/10.1080/07448481.2016.1271803DOI Listing
February 2018

Association between breath alcohol concentration and waterpipe lounge patrons' carbon monoxide exposure: A field investigation.

Drug Alcohol Depend 2017 Jan 16;170:152-155. Epub 2016 Nov 16.

Oklahoma Tobacco Research Center, Oklahoma City, OK, United States. Electronic address:

Background And Aims: Concurrent alcohol use and waterpipe (WP) smoking is common among young adults. WP smokers are more than twice as likely to use alcohol as non-users and frequently consume alcohol immediately before and during a WP smoking session. It is unclear what impact alcohol has on WP smoking patterns and resultant exposure to tobacco-related toxicants. The current research aimed to understand the association between alcohol consumption and WP smoke exposure among WP lounge patrons.

Methods: Seventy-one lounge patrons (66.2% male; M=27.03, SD=5.32) completed pre- and post-WP session self-report measures and biomarkers of smoking (expired carbon monoxide; eCO) and alcohol consumption (breath alcohol concentration; BrAC) upon entering and exiting the WP lounge.

Results: After controlling for number of bowls and charcoals smoked, greater consumption of alcohol was associated with greater smoke exposure among WP lounge patrons (p<0.05), such that a 0.1 unit increase in BrAC was associated with an eCO increase of 19.44ppm. This relationship was mediated by time spent in the WP lounge.

Conclusions: Concurrent alcohol use resulted in greater eCO, likley due to participants spending a greater amount of time in the WP lounge and experiencing longer sustained exposure to secondhand smoke. These findings illustrate a need for further research on the impact of alcohol consumption on WP smoking to assess the potential need for regulation of these products in WP lounges.
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http://dx.doi.org/10.1016/j.drugalcdep.2016.11.010DOI Listing
January 2017

Impacting Multiunit Housing Managers' Beliefs About the Benefits of Adopting Smoke-Free Policies: A Pilot Investigation.

Am J Health Promot 2018 Feb 9;32(2):271-273. Epub 2016 Nov 9.

2 Department of Marketing, College of Business, Oklahoma State University, Stillwater, OK, USA.

Purpose: To examine the influence of providing multiunit housing (MUH) managers with a resource manual for MUH smoke-free policy implementation on manager perceptions of smoke-free policies.

Design: One-group within-subject pretest-posttest design examining manager perceptions of smoke-free policies.

Setting: Random sampling of MUH managers in Oklahoma.

Participants: Forty-six MUH managers.

Intervention: The SMOKEFREE Landlord Manual (SLM) provides information on smoke-free policies and implementation resources.

Measures: Beliefs regarding implementation of smoke-free policies were measured on a Likert scale before and after receiving the manual.

Analysis: A general linear model examined changes in beliefs regarding implementation of a smoke-free policy.

Results: After receiving the manual, managers were more likely to agree with positive beliefs about smoke-free policies (Wilks λ = 0.59, F[18, 70] = 2.68, P < .01).

Conclusion: The MUH managers endorsed more positive beliefs regarding smoke-free policies following the receipt of the SLM.
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http://dx.doi.org/10.1177/0890117116670291DOI Listing
February 2018

Normative perceptions of alcohol-related consequences among college students.

Addict Behav 2016 Jul 10;58:16-20. Epub 2016 Feb 10.

Department of Psychology, Oklahoma State University, Stillwater, OK, United States.

College students in the U.S. continue to drink in hazardous ways and experience a range of alcohol-related consequences. Personalized feedback interventions (PFIs), which often include normative components comparing personal drinking to that of similar peers, have been effective in reducing alcohol outcomes among college students. Though normative perceptions of the quantity and frequency of alcohol use have been examined in many studies, norms for alcohol-related consequences have received less attention. The current study examined self-other discrepancies (SODs) for alcohol-related consequences among college students. Participants overestimated how often alcohol-related consequences are experienced by other same-sex students on campus and rated consequences as more acceptable for others to experience than themselves. No differences in SODs were found between those who did and did not report alcohol use. Future studies should examine the efficacy of PFIs that incorporate normative feedback on alcohol-related consequences.
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http://dx.doi.org/10.1016/j.addbeh.2016.02.008DOI Listing
July 2016

Informing alcohol interventions for student service members/veterans: Normative perceptions and coping strategies.

Addict Behav 2016 Jun 9;57:76-82. Epub 2016 Feb 9.

Department of Psychology, Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA. Electronic address:

Objective: The current study aimed to inform future interventions for heavy alcohol use and problems among college students by examining the utility of normative perceptions and coping strategies in predicting alcohol use among student service members/Veterans (SSM/Vs).

Methods: SSM/Vs and civilian students (N=319) at a large university in the Southern Plains completed self-report measures of demographics, alcohol use and related behaviors, and coping strategies.

Results: Both SSM/Vs and civilian students significantly overestimated the typical weekly drinking quantities and frequencies of same-sex students on campus. Among SSM/Vs, normative perceptions of typical student (not military-specific) drinking and substance-related coping strategies significantly predicted drinks consumed per week, while substance-related coping predicted alcohol-related consequences.

Conclusions: Despite the theoretical importance of similarity to normative referents, military-specific norms did not significantly improve the prediction of SSM/Vs' personal drinking behavior. Moreover, neither typical student nor military-specific norms predicted alcohol-related consequences among SSM/Vs after accounting for substance-related coping strategies. Future research may examine the efficacy of descriptive normative feedback and the importance of military-specific norms in alcohol interventions for SSM/Vs.
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http://dx.doi.org/10.1016/j.addbeh.2016.02.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775361PMC
June 2016
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