Publications by authors named "Jennifer L Pearson"

95 Publications

The "organic" descriptor and its association with commercial cigarette health risk expectancies, subjective effects, and smoking topography: a pilot human laboratory study.

Nicotine Tob Res 2021 Jul 21. Epub 2021 Jul 21.

Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia,PA.

Introduction: The purpose of this mixed method pilot study was to (1) examine whether the "organic" descriptor affects smokers' health risk expectancies, subjective ratings of smoking, and topography, and (2) describe how smokers interpret the "organic" descriptor and relate it to their subjective smoking experience.

Methods: Twenty-two daily smokers (45.5% men, 81.8% non-Hispanic White, M (SD) age = 47.3 [12.7], M (SD) cigarettes/day = 14.5 [5.1]) completed a within-person laboratory study. Following a baseline session, smokers attended 2 experimental sessions where they smoked a study-provided cigarette (identical across conditions) paired with either an "organic" or conventional (e.g., no "organic") descriptor condition and completed subjective and behavioral measures. Participants completed a semi-structured interview at the last visit.

Results: Relative to the conventional cigarette, more participants rated the "organic" cigarette as healthier, having fewer chemicals, and having a more favorable burn rate (p's<0.05). There were no differences in total puff volume by condition (p=0.42). Stratifying by gender, men inhaled 225 ml (SE = 82.7) more in the conventional condition (p=0.02); women inhaled 408 ml (SE = 233.3) more in the organic condition (p=0.11). A common understanding of "organic" was that the product was "…less processed... like less chemicals and it's more natural." Some believed that "organic" cigarettes contained fewer chemicals, which in turn produced a "much cleaner and healthier smoking cigarette" and that they could "taste the difference."

Conclusions: Findings support that smokers associate the "organic" descriptor with health and reduced harm. This descriptor may differentially impact puffing behavior by gender.

Implications: This study provides qualitative and quantitative data regarding how the "organic" descriptor influences adult daily smokers' perceptions and use of cigarettes. After smoking two identical cigarettes described as "organic" and conventional (e.g., no "organic"), smokers expressed more problematic health expectancies about the "organic" cigarette condition, providing further empirical support that the "organic" descriptor is associated with expectancies of reduced harm. The source of reduced harm was understood to be fewer chemicals in the organic cigarette. Though preliminary, findings suggest that "organic" may differentially affect puffing behavior by gender.
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http://dx.doi.org/10.1093/ntr/ntab151DOI Listing
July 2021

Articulating the Trauma-Informed Theory of Individual Health Behavior.

Stress Health 2021 May 19. Epub 2021 May 19.

Joint Doctoral Program in Interdisciplinary Research on Substance Use, San Diego State University and University of California, San Diego, California, USA.

Exposure to trauma increases the risk of engaging in detrimental health behaviours such as tobacco and substance use. In response, the United States Substance Abuse and Mental Health Services Administration developed Trauma-Informed Care (TIC), an organisational framework for improving the provision of behavioural health care to account for the role exposure to trauma plays in patients' lives. We adapt TIC to introduce a novel theory of behaviour change, the Trauma-Informed Theory of Individual Health Behavior (TTB). TTB posits that individual capacity to undertake intentional health-promoting behaviour change is dependent on three factors: (1) the forms and severity of trauma they have been and are exposed to, (2) how this trauma physiologically manifests (i.e., the trauma response) and (3) resilience to undertake behaviour change despite this trauma response. We define each of these factors and their relationships to one another. We anticipate that the introduction of TTB will provide a foundation for developing theory-driven research, interventions, and policies that improve behavioural health outcomes in trauma-affected populations.
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http://dx.doi.org/10.1002/smi.3068DOI Listing
May 2021

Naming Racism, not Race, as a Determinant of Tobacco-Related Health Disparities.

Nicotine Tob Res 2021 05;23(6):885-887

National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.

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http://dx.doi.org/10.1093/ntr/ntab059DOI Listing
May 2021

The influence of cultural food security on cultural identity and well-being: a qualitative comparison between second-generation American and international students in the United States.

Ecol Food Nutr 2021 Feb 25:1-27. Epub 2021 Feb 25.

School of Community Health Sciences, University of Nevada Reno, Reno, Nevada, USA.

The purpose of this study was to explore the impact of cultural food insecurity on identity and well-being in second-generation American and international university students. Thirty-one semi-structured interviews were conducted from January-April 2020. Audio transcripts were analyzed using continuous and abductive thematic analysis. Students indicated that cultural foodways enhanced their well-being by facilitating their cultural/ethnic identity maintenance, connection, and expression. Conversely, cultural food insecurity diminished student well-being due to reduced cultural anchors, highlighting the importance of cultural food in this population. Universities that reduce cultural foodways barriers may mitigate cultural food insecurity for second-generation American and international university students. (100/100).
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http://dx.doi.org/10.1080/03670244.2021.1875455DOI Listing
February 2021

The impact that cultural food security has on identity and well-being in the second-generation U.S. American minority college students.

Food Secur 2021 Jan 25:1-15. Epub 2021 Jan 25.

School of Community Health Sciences, University of Nevada Reno, 1664 N. Virginia Street, Reno, NV 89557 USA.

Food contributes to an individual's physical and mental well-being and expresses one's cultural identity through preparation, sharing, and consumption (i.e., foodways). Inadequate access to cultural foods can create cultural stress and affect one's identity and well-being. In particular, second-generation U.S. American student populations may have a higher risk for cultural stress due to being away from family, academic stress, environmental changes, and diminished financial stability to purchase cultural foods. Thus, an exploratory qualitative methodology was used to elicit information about second-generation U.S. Americans' food experiences to identify how cultural foods play a role in individual identity and how individual well-being is influenced by the presence or lack of cultural foods. Sixteen semi-structured interviews were conducted with second-generation American students at the University of Nevada, Reno, who self-identified as a cultural or ethnic minority. A standard thematic analysis was conducted. The authors identified that cultural food security influenced the ability to practice foodways, which tied Second-generation American students to their cultural identities. The absence of foodways led to anxiety and depression among students, amplifying the feelings of identity degradation. Second-generation American students discussed that the ability to practice their foodways improved multiple well-being components and led to feelings of happiness, decreased stress, warmth, better digestion, and a sense of belonging, comfort, and safety. College populations continue to grow and become more diverse, and with the increasing Second-generation American students, it is essential to improve the access and availability of cultural foods to improve their overall well-being. (245/250 words).

Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-020-01140-w.
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http://dx.doi.org/10.1007/s12571-020-01140-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829482PMC
January 2021

Understanding the Complex Relationship Between E-cigarette Use, Other Substance Use, and Mental Health in Adolescence.

Nicotine Tob Res 2021 02;23(3):413-414

Division of Social and Behavioral Sciences/Health Administration and Policy, University of Nevada-Reno, Reno, NV.

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http://dx.doi.org/10.1093/ntr/ntaa274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885775PMC
February 2021

Seeking safety: a focus group study of young adults' cannabis-related attitudes, and behavior in a state with legalized recreational cannabis.

Harm Reduct J 2020 11 26;17(1):92. Epub 2020 Nov 26.

Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada, Reno, USA.

Background: Only July 1, 2017, Nevada became the fifth US state to allow the legal sale of recreational cannabis products for adults ages of 21 and over. This study investigates young adults' cannabis-related attitudes, perceptions, and behaviors in a state where recreational and medical cannabis use was recently legalized.

Methods: We conducted 8 focus groups stratified by cannabis use (regular users, occasional users, and nonusers) with 32 college students ages 18 to 24. Data were analyzed using the inductive qualitative thematic analysis method.

Results: Four themes emerged during analyses: "sort of legal," "mitigating harm through legalization," "Increasing acceptance," and "seeking safety when purchasing cannabis." Despite their limited knowledge of cannabis regulation, the majority of the participants supported recreational cannabis legalization from a harm reduction perspective. Most participants did not believe that cannabis legalization had affected their use behavior. However, participants, especially cannabis users, perceived that recreational cannabis legalization created a context where cannabis use was legally, socially, and behaviorally "safer" than in an illegal context, even for those below the legal age of sale.

Conclusions: Most studies focus on the role of perceived health risk on cannabis use. If there are population-level long-term effects of recreational cannabis legalization on use behavior, findings suggest that they will be mediated by the perceived legal, social, and behavioral risk of using cannabis.
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http://dx.doi.org/10.1186/s12954-020-00442-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689992PMC
November 2020

Association of Electronic Nicotine Delivery System Use With Cigarette Smoking Progression or Reduction Among Young Adults.

JAMA Netw Open 2020 11 2;3(11):e2015893. Epub 2020 Nov 2.

Westat, Rockville, Maryland.

Importance: The prevalence of electronic nicotine delivery systems (ENDS) use, including e-cigarettes, among US young adults (YAs) has raised questions about how these products may affect future tobacco and nicotine use among YAs. Given this prevalence and that young adulthood is a critical period for the establishment of tobacco and nicotine use, it is important to consider the association between ENDS use and cigarette smoking specifically in this age group.

Objective: To examine whether ENDS use frequency or intensity is associated with changes in cigarette smoking among US YA ever smokers during 1 year.

Design, Setting, And Participants: This cohort study used 3 waves of data (2013-2014, 2014-2015, and 2015-2016) from the Population Assessment of Tobacco and Health (PATH) Study, an ongoing longitudinal cohort study of adults and youth. Unweighted 1:6 propensity score matching was used to match participants on wave 1 risk factors for ENDS use at wave 2. The changes in smoking between wave 2 and wave 3 were assessed using the matched sample. In total, 1096 ENDS-naive, ever cigarette-smoking YAs (18-24 years of age) at wave 1 who participated in wave 2 and wave 3 and who had complete data in the PATH Study were included in the analyses, which were conducted from August 2018 to October 2019.

Exposures: Never ENDS use (n = 987), any previous 30-day ENDS use (n = 109), 1 to 5 days of ENDS use in the previous 30 days (n = 75), and 6 or more days ENDS use in the previous 30 days at wave 2 (n = 34).

Main Outcomes And Measures: The analytic sample was selected using multiple variables based on peer-reviewed literature supporting associations with ENDS use. The main outcomes-changes in cigarette smoking behavior between wave 2 and wave 3-were defined using 2 measures: (1) change in smoking frequency, defined as the number of smoking days in the previous 30 days at wave 3 vs wave 2, and (2) change in smoking intensity, defined as the number smoking days in the previous 30 days multiplied by the mean number of cigarettes consumed on smoking days at wave 3 vs wave 2.

Results: The present cohort analyses included 1096 YA ever smokers who were ENDS naive at wave 1. The majority of the sample were women (609 [55.6%]) and White individuals (698 [63.7%]), and the mean (SD) age was 21.4 (1.9) years. In wave 1, 161 YAs (14.7%) were daily smokers in the previous 30 days. After propensity score matching, no statistically significant associations were observed between any definition of wave 2 ENDS use and changes in either the frequency or intensity of smoking at wave 3.

Conclusions And Relevance: In this cohort study of US YA ever smokers, ENDS use was not associated with either decreased or increased cigarette smoking during a 1-year period. However, it is possible that the rapidly evolving marketplace of vaping products may lead to different trajectories of YA cigarette and ENDS use in the future.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.15893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686868PMC
November 2020

Cannabis use and driving under the influence: Behaviors and attitudes by state-level legal sale of recreational cannabis.

Prev Med 2020 12 5;141:106320. Epub 2020 Nov 5.

School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.

Background: As states continue to legalize the sale of recreational cannabis, there is a need to study attitudes and behaviors regarding driving after cannabis use. The purpose of this study was to describe US adults' attitudes and behaviors regarding driving after cannabis use by state-level legal sale of recreational cannabis, and to determine whether these associations differ by frequency of cannabis use.

Methods: Data were collected from a national sample of 17,112 adults in the United States. Weighted adjusted prevalence ratios and 95% confidence intervals were used to compare the prevalence of behaviors and attitudes by state-level legal sale of recreational cannabis. Analyses were repeated among recent cannabis users, stratifying by cannabis use status.

Results: Driving after cannabis use was more prevalent in legal cannabis sales states; however, so were potentially protective attitudes related to cannabis use and driving. After stratifying by frequency of use, daily/almost daily, weekly/monthly, and past 12-month users from states with legal recreational cannabis sales had significantly lower prevalence of driving after cannabis use and higher prevalence of protective attitudes compared to those from states without legal recreational sales. Risk perceptions were lower for cannabis than alcohol.

Conclusions: Public health messaging campaigns to reduce driving and riding after cannabis use and to improve attitudes regarding driving after cannabis use are warranted across all U.S. states, regardless of legalization status.
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http://dx.doi.org/10.1016/j.ypmed.2020.106320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083159PMC
December 2020

Menthol and Mint Cigarettes and Cigars: Initiation and Progression in Youth, Young Adults and Adults in Waves 1-4 of the PATH Study, 2013-2017.

Nicotine Tob Res 2021 08;23(8):1318-1326

Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

Introduction: This study examined in youth (12-17 years), young adults (18-24 years), and adults (25+ years): (1) the prevalence of the first menthol cigarette and menthol/mint cigar use among new tobacco users; (2) association between the first menthol/mint use, subsequent tobacco use, and nicotine dependence ~1 year later compared with the first non-menthol/mint use.

Aims And Methods: Longitudinal analysis of data from Waves 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2017; 10 086 youth and 21 281 adults). Main outcome measures were past 12-month and past 30-day cigarette and cigar use, and nicotine dependence.

Results: Youth and young adult new cigarette users are more likely to smoke a menthol cigarette or indicate that they do not know the flavor compared with adults aged 25+. A greater proportion of adults aged 25+ first used menthol/mint-flavored cigars (13.4%) compared with youth (8.5%) and young adults (7.4%). Among young adults, first use of a menthol cigarette is associated with past 12-month use of cigarettes at the subsequent wave and first use of any menthol/mint-flavored cigars is associated with past 30-day use of these products at the subsequent wave in both youth and young adults. In youth and adults, there were no significant relationships between first use of a menthol/mint cigarette or cigar and nicotine dependence scores at a subsequent wave in multivariable analyses.

Conclusions: The first use of menthol/mint cigarettes and cigars is associated with subsequent cigarette and cigar use in young people aged 12-24.

Implications: This study examined the relationship between initiation with menthol cigarettes and menthol/mint cigars, subsequent tobacco use, and nicotine dependence in US youth, young adults, and adults who participated in Waves 1-4 of the Population Assessment of Tobacco and Health study. New use of menthol cigarettes was associated with greater past 12-month cigarette use in young adults and new use of menthol/mint-flavored cigars was associated with greater past 30-day cigar use in youth and young adults compared with non-menthol use. Initiation with menthol/mint cigarette and cigar products may lead to subsequent use of those products.
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http://dx.doi.org/10.1093/ntr/ntaa224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360630PMC
August 2021

Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults.

Prev Med 2020 11 15;140:106285. Epub 2020 Oct 15.

Schroeder Institute at Truth Initiative, United States of America.

Low harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18-40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.
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http://dx.doi.org/10.1016/j.ypmed.2020.106285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779116PMC
November 2020

"It's really addictive and I'm trapped:" A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people.

Addict Behav 2021 01 3;112:106599. Epub 2020 Aug 3.

Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Background: Debate continues over how e-cigarettes have impacted the health of young people, and what regulatory policies should be enacted. The debate has appropriately been informed by quantitative studies, often focused on initiation, prevalence, and product transition among the general population and demographic segments. Factors driving cessation and subjective experiences that motivate young users to quit have been largely absent from the debate. This qualitative study highlights the range of motivating experiences among a population of treatment-seeking young e-cigarette users.

Methods: Three researchers coded reasons for quitting provided by a sample of n = 1000 youth (13-17) and n = 1000 young adults (18-24) enrolled in a text message cessation program. Data spanned January 18 - February 22, 2019. Codes were adapted from previous literature.

Results: The most common reasons were health (50.9%; "I want my lungs back"), financial cost (21.7%; "I don't have enough money to feed my addiction"), freedom from addiction (16.0%; "i hate juuling. it's taking over my life"), and social influence (10.1%; "it's affecting my friendships"). Selected quotes highlight a broad range of additional ways in which e-cigarette use negatively impacted young people, including decreased academic performance and mental health.

Conclusions: Young people trying to quit e-cigarettes are motivated by a diversity of reasons including health, financial, social, and academic. The range of impacts should be considered in discussions of policies intended to protect young people, and incorporated into cessation programs designed to serve them.
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http://dx.doi.org/10.1016/j.addbeh.2020.106599DOI Listing
January 2021

Smokers' Exposure to Perceived Modified Risk Claims for E-Cigarettes, Snus, and Smokeless Tobacco in the United States.

Nicotine Tob Res 2021 02;23(3):605-608

Department of Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, NV.

Introduction: Based on arguments for harm reduction and health benefits, tobacco companies in the United States can apply for regulatory authorization to make "modified risk tobacco product" (MRTP) marketing claims. The impact of future MRTP claims may depend on whether they are noticed, believed, and lead to smokers switching products. This study provides baseline data about smokers' exposure to perceived MRTP claims ahead of any MRTP authorizations.

Aims And Methods: We analyzed measures from Wave 3 of the US-based Population Assessment of Tobacco and Health (PATH) study which asked smokers to indicate if they had seen any e-cigarettes, snus, or other smokeless tobacco (SLT) products that claim to be "less harmful" in the past 12 months, and their likelihood of using products with these claims in the next 30 days.

Results: Significantly fewer smokers noted having seen snus (5.1%) or other SLT (5.6%) with "less harmful" claims compared with e-cigarettes (29.1%). For each product, the prevalence of MRTP claim exposure was higher among smokers who perceived the product to be less harmful than smoking, who currently used the product, and who had higher rates of tobacco advertising exposure at the point of sale. Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%).

Conclusions: Ahead of any Food & Drug Administration (FDA) authorization for MRTP claims, some smokers already perceive exposure to "less harmful" claims for e-cigarettes, but few do for SLT. MRTP claims may motivate some smokers to use these products.

Implications: This study provides new baseline data about smokers' perceived exposure to MRTP claims in the United States ahead of any regulatory claim authorization. Using data from Wave 3 of the US PATH study, we found that some smokers already perceive exposure to "less harmful" claims for e-cigarettes (29%), but few do for SLT (5%-6%). Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%), suggesting MRTP claims may motivate some smokers to use products described as "less harmful."
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http://dx.doi.org/10.1093/ntr/ntaa159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885787PMC
February 2021

Intensive Longitudinal Study of the Relationship Between Cigalike E-cigarette Use and Cigarette Smoking Among Adult Cigarette Smokers Without Immediate Plans to Quit Smoking.

Nicotine Tob Res 2021 02;23(3):527-534

Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY.

Introduction: This study examined the association between the introduction of an e-cigarette and subsequent change in cigarette smoking among smokers who were not immediately interested in quitting.

Aims And Methods: The Moment Study was a 21-day intensive longitudinal study with an online follow-up survey at 30 days. After observing baseline cigarette smoking for 1 week, participants received 10 cigalike e-cigarettes on study days 6 and 13. Participants reported cigarettes per day, e-cigarette puffs per day, and e-cigarette satisfaction using text-message-based surveys.

Results: The sample of 96 daily smokers was majority female (53.1%), African American (67.7%), and non-Hispanic (95.8%). When e-cigarettes were provided (day 6), average cigarettes per day dropped by 1.82 cigarettes (p < .0001). The within-person e-cigarette puff effect on daily cigarette smoking was significantly negative (β = -0.023; p = .005); a participant who consumed 100 more e-cigarette puffs in a day than usual for that person was expected to smoke 2.3 fewer cigarettes that day, but this was only true for non-menthol smokers (p = .006). Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps < .05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up.

Conclusions: Giving e-cigarettes to smokers who did not intend to quit reduced their cigarette smoking on days when they used e-cigarette more frequently, but this relationship did not hold for menthol smokers. Satisfaction with e-cigarette use was predictive of continued use 30 days later.

Implications: A greater amount of cigalike e-cigarette use resulted in less smoking among adult daily smokers without immediate plans to quit, but a lack of nicotine delivery and satisfaction for these devices may have limited their utility as a replacement for cigarette smoking, especially among menthol smokers. The global concept of "satisfaction" may be an important driver of e-cigarette use among adult smokers.
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http://dx.doi.org/10.1093/ntr/ntaa086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885790PMC
February 2021

Commentary on Beard et al. (2019): A systematic approach sharpens insights on e-cigarettes and smoking cessation.

Addiction 2020 05 28;115(5):975-976. Epub 2020 Jan 28.

Division of Social and Behavioral Sciences/Health Administration and Policy, University of Nevada, Reno, Reno, NV, USA.

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http://dx.doi.org/10.1111/add.14963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271740PMC
May 2020

It Is Past Time to Consider Cannabis in Vaping Research.

Nicotine Tob Res 2020 04;22(5):597-598

Department of Health, Behaviour & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

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http://dx.doi.org/10.1093/ntr/ntaa012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171266PMC
April 2020

Do inequalities add up? Intersectional inequalities in smoking by sexual orientation and education among U.S. adults.

Prev Med Rep 2020 Mar 23;17:101032. Epub 2019 Dec 23.

Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada, Reno, USA.

Introduction: Inequalities in smoking by socio-economic status (SES) are well-known. A growing body of literature has demonstrated additional inequalities in smoking by sexual orientation. This study used an intersectional lens to examine smoking at the intersection of sexual orientation and education.

Methods: Data come from 28,362 adult participants in Wave 2 (2014-2015) of the Population Assessment of Tobacco and Health (PATH) Study. We used educational level (less than high school education (HS); HS or more) and sexual orientation (heterosexual; sexual minority) to form four intersectional positions.We estimated prevalence differences in smoking corresponding to joint, referent, and excess intersectional inequalities using weighted linear binomial regression models. Results were stratified by gender and adjusted for ethnicity and age.

Results: The adjusted joint inequality represented 7.6% points (p.p.) (95% CI: 2.5, 12.8) difference in smoking between the doubly advantaged (heterosexual with HS or more) and doubly disadvantaged (sexual minority with less than HS) positions. Joint inequality was decomposed into referent SES inequality (12.5 p.p. (95% CI: 10.5, 14.4)); referent sexual orientation inequality (9.7 p.p. (95% CI: 6.8, 12.6)); and a substantial negative excess intersectional inequality (-14.6 p.p. (95% CI: -20.8, -8.3)), attributed to an unexpectedly low prevalence of smoking among doubly disadvantaged persons. Similar overall patterns were found in the stratified analyses.

Conclusions: We found that "doubly-disadvantaged" group of low-educated sexual minority adults did not have the greatest burden of smoking; whereas, low-educated heterosexual adults had the highest smoking prevalence. Our findings support tailoring cessation interventions to disadvantaged groups' different needs.
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http://dx.doi.org/10.1016/j.pmedr.2019.101032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957789PMC
March 2020

Youth Vaping and Tobacco Use in Context in the United States: Results From the 2018 National Youth Tobacco Survey.

Nicotine Tob Res 2021 02;23(3):447-453

University of Nevada, Reno School of Community Health Sciences, Reno, NV.

Introduction: According to the National Youth Tobacco Survey (NYTS), youth e-cigarette use (vaping) rose between 2017 and 2018. Frequency of vaping and concurrent past 30-day (p30d) use of e-cigarettes and tobacco products have not been reported.

Methods: We analyzed the 2018 NYTS (N = 20 189) for vaping among all students (middle and high school; 6-12th grades; 9-19 years old) by frequency of vaping, exclusive vaping, p30d poly-product use (vaping and use of one or more tobacco product), and any past tobacco product use.

Results: In 2018, 81.4% of students had not used any tobacco or vapor product in the p30d, and 86.2% had not vaped in the p30d. Among all students, of the 13.8% vaped in the p30d, just over half vaped on ≤5 days (7.0%), and roughly a quarter each vaped on 6-19 days (3.2%) and on 20+ days (3.6%). Almost three quarters of p30d vapers (9.9%) reported past or concurrent tobacco use and the remainder (3.9%) were tobacco naïve. 2.8% of students were tobacco naïve and vaped on ≤5 days; 0.7% were tobacco-naïve and vaped on 6-19 days, and 0.4% were tobacco-naïve and vaped on 20+ days.

Conclusions: Vaping increased among US youth in 2018 over 2017. The increases are characterized by patterns of low p30d vaping frequency and high poly-product use, and a low prevalence of vaping among more frequent but tobacco naïve vapers.

Implications: Results underscore the importance of including the full context of use patterns. The majority of vapers (60.0%-88.9% by use frequency) were concurrent p30d or ever tobacco users. About 4% of students were tobacco naïve and vaped in the p30d, but few (0.4%) vaped regularly on 20 or more days. Reporting youth vaping data with frequency and tobacco product co-use will give public health decision-makers the best possible information to protect public health.
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http://dx.doi.org/10.1093/ntr/ntaa010DOI Listing
February 2021

"Tobacco and Water": Testing the Health Halo Effect of Natural American Spirit Cigarette Ads and Its Relationship with Perceived Absolute Harm and Use Intentions.

Health Commun 2021 06 10;36(7):804-815. Epub 2020 Jan 10.

Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health.

In 2015, the FDA formally warned Santa Fe Natural Tobacco Company that their "natural" and "additive-free" claims for its Natural American Spirit cigarettes conveyed reduced harm to consumers. In a settlement, Santa Fe was allowed to continue using the word "natural" in the brand name and the phrase "tobacco and water". The company also uses eco-friendly language and plant imagery and these tactics have also been shown to communicate reduced product harm. In this study, we propose the health halo effect as an overarching framework for explaining how these ad tactics mislead consumers in an effort to provide more comprehensive guidance for regulatory action. In a between-subjects experiment, 1,577 US young adults, ages 18-24, were randomly assigned to view one of five Natural American Spirit cigarette ads featuring either: 1) eco-friendly language; 2) plant imagery; 3) the phrase "tobacco and water"; 4) all of these tactics; or 5) a control condition featuring none of these tactics. In line with past research, ads with the phrase "tobacco and water" or with all the tactics together (vs. control) created a health halo effect, increasing perceptions that Natural American Spirit cigarettes were healthier and had less potential to cause disease; these tactics also had an indirect positive effect on smoking intentions through reduced perceptions of the brand's potential to cause disease and perceived absolute harm. Inconsistent with prior work, the eco-friendly language and plant imagery (vs. control) reduced healthfulness perceptions, increased perceptions of absolute harm, and had an indirect negative effect on smoking intentions. We contribute to past research showing that Natural American Spirit cigarette ad tactics mislead consumers. Inconsistent findings are explained in terms of stimuli design and processing of message features, indices of relative message persuasiveness, and multiple versus single-message designs.
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http://dx.doi.org/10.1080/10410236.2020.1712526DOI Listing
June 2021

Mining User-Generated Content in an Online Smoking Cessation Community to Identify Smoking Status: A Machine Learning Approach.

Decis Support Syst 2019 Jan 15;116:26-34. Epub 2018 Oct 15.

Schroeder Institute, Truth Initiative, Washington, District of Columbia, United States of America.

Online smoking cessation communities help hundreds of thousands of smokers quit smoking and stay abstinent each year. Content shared by users of such communities may contain important information that could enable more effective and personally tailored cessation treatment recommendations. This study demonstrates a novel approach to determine individuals' smoking status by applying machine learning techniques to classify user-generated content in an online cessation community. Study data were from BecomeAnEX.org, a large, online smoking cessation community. We extracted three types of novel features from a post: domain-specific features, author-based features, and thread-based features. These features helped to improve the smoking status identification (quit vs. not) performance by 9.7% compared to using only text features of a post's content. In other words, knowledge from domain experts, data regarding the post author's patterns of online engagement, and other community member reactions to the post can help to determine the focal post author's smoking status, over and above the actual content of a focal post. We demonstrated that machine learning methods can be applied to user-generated data from online cessation communities to validly and reliably discern important user characteristics, which could aid decision support on intervention tailoring.
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http://dx.doi.org/10.1016/j.dss.2018.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6934371PMC
January 2019

Latent Classes of Nicotine Beliefs Correlate with Perceived Susceptibility and Severity of Nicotine and Tobacco Products in US young adults.

Nicotine Tob Res 2019 12;21(Suppl 1):S91-S100

Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY.

Background: Pervasive misperceptions about nicotine may influence uptake of quit smoking aids and the impact of policies addressing nicotine as a tobacco product constituent.

Methods: Latent class analyses were conducted using four items on nicotine beliefs asked of 4037 adults aged 18-40 in wave 9 (February-March 2016) of the Truth Initiative Young Adult Cohort Study. Confirmatory factor analyses identified three factors from 12 items: nicotine susceptibility (NSUS), nicotine severity (NSEV), and tobacco severity (TSEV). Analyses assessed correlations between latent classes, sociodemographics, and nicotine/tobacco factor scores.

Results: A four-class model of nicotine beliefs was the best fit, with the largest class believing that nicotine plays a major part in smoking risks (class 1, n = 2070; 52%). Class 2 shared that belief but also responded "Don't know" to addiction questions (class 2, n = 382; 11%). Fewer belonged in class 3, who reported that nicotine plays a small part in health risks (n = 1277; 30%), and class 4, who perceived nicotine as not cancer causing (n = 308; 7%). Latent class membership was correlated with sociodemographics, peer smoking, and past 30-day tobacco use. Classes 1 and 2 had similar NSUS scores and classes 3 and 4 had similar NSEV and TSEV scores.

Discussion: Differences in the perceptions of nicotine and tobacco-related harms can be partially explained by clustering of underlying nicotine beliefs. These classes of beliefs are correlated with sociodemographic predictors of smoking. These findings may help to identify specific beliefs or groups to be targeted by public education efforts on nicotine.

Implications: The current study supports that underlying nicotine beliefs are associated with perceived harms of specific nicotine and tobacco products (relative to cigarettes), with greater false beliefs about nicotine correlated with greater perceived susceptibility to nicotine addiction. Two important inferences emerge from this study: first, that education to address nicotine beliefs may also reframe perceptions of the harms of nicotine and tobacco products; and second, that this type of education may differentially impact perceptions of the harms of nicotine products (e.g., nicotine replacement therapy and e-cigarettes) and tobacco products (e.g., cigars, smokeless, and hookah).
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http://dx.doi.org/10.1093/ntr/ntz156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939776PMC
December 2019

Depression as a moderator of the prospective relationship between mood and smoking.

Health Psychol 2020 Feb 4;39(2):99-106. Epub 2019 Nov 4.

Department of Psychology, American University.

Objective: Affective features of depression are uniquely involved in the depression-smoking relationship, and it follows that smokers with depression are likely to use cigarettes to alleviate negative affect. However, most ecological momentary assessment (EMA) studies demonstrate no relationship between mood and smoking, in general. Conversely, a small number of experimental studies suggest there is an association between mood and smoking and that the relationship is dependent on levels of depression. Researchers have yet to examine the impact of depression on the relationship between mood and smoking using EMA methodology. Accordingly, the aim of this study was to explore the relationship between depression, mood, and ad lib smoking among adults in "real time."

Method: Participants included 96 adult daily smokers (53% female, 67% non-Hispanic Black; age, M = 40.76, SD = 12.42) who completed baseline ratings of depressive symptoms and 7 consecutive days of in vivo data collection focused on cigarette smoking and associated mood and craving ratings.

Results: Results indicated that depression moderates the prospective relationship between mood and smoking (even when controlling for craving), such that participants with higher levels of depressive symptoms smoke more cigarettes in response to an improvement in mood (relative to their average mood), whereas participants with lower levels of depressive symptoms smoke more in response to worsening mood states (relative to their average mood).

Conclusions: Attempting to maintain better mood may be a motivating factor for smoking among depressed individuals. These findings may be helpful in tailoring smoking cessation treatment programs for people exhibiting depressive symptoms. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/hea0000816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957712PMC
February 2020

An exploratory analysis of adult daily smokers' experiences using e-cigarettes in smoke-free places.

Tob Induc Dis 2018 19;16:54. Epub 2018 Nov 19.

School of Community Health Sciences, University of Nevada, Reno, United States.

Introduction: Evidence indicates that one reason cigarette smokers value e-cigarettes is the ability to use them in places where smoking is not permitted. We sought to: 1) explore adult daily smokers' experiences using e-cigarettes in the context of smoke-free places; and 2) describe smokers' perceptions of bystanders' reactions.

Methods: Twenty adult daily smokers in Washington, DC initiated e-cigarettes for three weeks and completed in semi-structured interviews at the end of each week. All interviews (n=60) were digitally-recorded, transcribed verbatim, imported into NVivo 10.0, and analyzed using thematic analysis methodology.

Results: The sample had a mean age of 37.9 years and 18 participants reported having smoked their first cigarette by age 18. Common themes included descriptions of: 1) uncertainty about whether smoke-free policies included e-cigarettes; 2) using e-cigarettes in smoke-free places (e.g. restaurants, workplace, public transit-bus and rail); 3) approaches to e-cigarette use in smoke-free places as part of a complex decision-making process, ranging from testing and establishing the social and spatial boundaries of e-cigarette use, to confining e-cigarette use to inside their home; and 4) favorable, unfavorable, and impartial reactions from bystanders facilitated or impeded e-cigarette use, indicating social approval/social disapproval.

Conclusions: Results suggest a continuum of factors, including smoke-free policies and reactions from bystanders may facilitate or impede e-cigarette use among smokers in environments where a smoke-free imperative is well-established. As e-cigarette use evolves, study findings indicate the importance of the social environment and how it could affect those switching from cigarettes to e-cigarettes.
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http://dx.doi.org/10.18332/tid/98958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659561PMC
November 2018

What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults.

Int J Equity Health 2019 07 17;18(1):109. Epub 2019 Jul 17.

Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Background: Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; however, there is a lack of research examining the social processes driving these complex inequalities. Using an intersectional framework, the current study examines key processes contributing to inequalities in smoking between four intersectional groups by education and sexual orientation.

Methods: The sample (28,362 adults) was obtained from Wave 2 (2014-2015) of the Population Assessment of Tobacco and Health (PATH) Study. Four intersectional positions were created by education (high- and low-education) and sexual orientation (heterosexual or lesbian, gay, bisexual, or queer/questioning (LGBQ). The joint inequality, the referent socio-economic inequality, and the referent sexual orientation inequality in smoking were decomposed by demographic, material, tobacco marketing-related, and psychosocial factors using non-linear Oaxaca decomposition.

Results: Material conditions made the largest contribution to the joint inequality (9.8 percentage points (p.p.), 140.9%), referent socio-economic inequality (10.01 p.p., 128.4%), and referent sexual orientation inequality (4.91 p.p., 59.8%), driven by annual household income. Psychosocial factors made the second largest contributions to the joint inequality (2.12 p.p., 30.3%), referent socio-economic inequality (2.23 p.p., 28.9%), and referent sexual orientation inequality (1.68 p.p., 20.5%). Referent sexual orientation inequality was also explained by marital status (20.3%) and targeted tobacco marketing (11.3%).

Conclusion: The study highlights the pervasive role of material conditions in inequalities in cigarette smoking across multiple dimensions of advantage and disadvantage. This points to the importance of addressing material disadvantage to reduce combined socioeconomic and sexual orientation inequalities in cigarette smoking.
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http://dx.doi.org/10.1186/s12939-019-1015-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637561PMC
July 2019

Prevalence and correlates of nicotine and nicotine product perceptions in U.S. young adults, 2016.

Addict Behav 2019 11 10;98:106020. Epub 2019 Jun 10.

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

Introduction: Nicotine is not a human carcinogen and combustion compounds in tobacco smoke, rather than nicotine, cause tobacco-related cardiovascular disease. Few recent studies examine the public's beliefs about nicotine in relation to smoking.

Methods: Participants aged 18-40 (n = 4,091) in Wave 10 (Fall 2016) of the Truth Initiative Young Adult Cohort Study responded to nineteen items on nicotine and nicotine product perceptions, including addictiveness and health harms of nicotine patch/gum and e-cigarettes compared to cigarettes. Analyses conducted in 2018 examined prevalence of perceptions and sociodemographic and tobacco use correlates of selected perceptions.

Results: The majority of young adults reported that nicotine was responsible for a "relatively" or "very large" part of the health risks (66%) and cancer (60%) caused by smoking. More than half of young adults (55%) believed that nicotine is a cause of cancer. Between 23% and 43% of young adults responded "don't know" to items on nicotine. Females, blacks, Hispanics, and those with less than some college education were more likely to report true or "don't know" vs. false to "nicotine is a cause of cancer" and had higher odds of believing that nicotine was responsible for a "relatively" or "very large" part of the health risks of smoking and cancer caused by smoking. Past 30-day tobacco users had lower odds of reporting these beliefs.

Conclusions: Misperceptions of nicotine are widespread in young adults. Public education is needed to maximize the public health impact of FDA's required nicotine warning label and proposed nicotine reduction policies.
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http://dx.doi.org/10.1016/j.addbeh.2019.06.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947657PMC
November 2019

Limited utility of detailed e-cigarette use measures: An analysis of NESARC-III.

Addict Behav 2019 10 2;97:56-62. Epub 2019 May 2.

Department of Psychiatry, Vermont Center on Behavior & Health, University of Vermont, 1 South Prospect Street, SATC-UHC, Burlington, VT 05401, United States.

Introduction: The heterogeneity of e-cigarette products and e-liquids pose challenges to surveillance of e-cigarette exposure. The goal of this study was to evaluate the internal consistency of e-cigarette use frequency, quantity, and duration measures in a national population-based survey.

Methods: Data were drawn from the 2012-2013 for the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 36,309; NESARC-III). Adults who used e-cigarettes/e-liquid during the past year (≤18 years old; n = 1,229) were asked about their age of first use, recency of use, quantity (i.e., cartridges, drops), nicotine concentration, and duration (hours). Several internal consistency parameters were compared for e-cigarette measures in past-year (n = 750) and past 30-day e-cigarette users (n = 472) overall, and by frequency of use (i.e., infrequent [≤3 days/month], non-daily [1-6 days/week], daily).

Results: There were no significant differences in quantity, nicotine concentration, or duration by frequency of use in past 30-day e-cigarette users. One-third of past 30-day and almost half of past-year users did not know the nicotine concentration of their cartridge or e-liquid. Correlations between all e-cigarette use measures were low, with the highest correlations seen between e-liquid quantity and cartridge quantity in all past 30-day users (r = 0.28) and those reporting any e-liquid use (r = 0.40). Cronbach's alpha and mean interitem correlations were low across all user groups.

Conclusions: Low to moderate correlation across e-cigarette measures in e-cigarette users implies low internal consistency of these measures in a population survey. Findings suggest measures such as quantity and nicotine concentration might more appropriate in samples of recent experienced e-cigarette users than in general population samples.
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http://dx.doi.org/10.1016/j.addbeh.2019.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681650PMC
October 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

Re: Disregarding the impact of nicotine on the developing brain when evaluating costs and benefits of noncombustible nicotine products.

Prev Med 2019 03;120:158-159

Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York University, New York, NY, United States of America.

This Letter to the Editor is in response to a letter from Ms. Flannery, titled, "Disregarding the impact of nicotine on the developing brain when evaluating costs and benefits of noncombustible nicotine products". In our response, we address some concerns raised by Ms. Flannery, and reiterate our position in our original article. In particular, we underline the importance of a rational public health calculus that weighs beneficial and harmful consequences of policies related to noncombustible nicotine product (NNP) use. We further emphasize the need to correct misperceptions about relative risk of different products to encourage smokers to switch to NNPs. Lastly, we are explicit about our assertion that no use of any nicotine-containing products is the only way to avoid harm at any age, but that we must view this issue pragmatically for the benefit of public health.
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http://dx.doi.org/10.1016/j.ypmed.2018.12.027DOI Listing
March 2019

Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey.

Nicotine Tob Res 2019 06;21(7):970-973

Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ.

Significance: US smokers of Natural American Spirit, a brand marketed as "organic" and "additive-free," are more likely than other cigarette smokers to believe that their brand might be less harmful than other brands. This article (1) describes the prevalence of belief that "organic" and "additive-free" tobacco is less harmful than regular tobacco products in the US population and (2) describes the sociodemographic characteristics of adults who believe tobacco products with these descriptors are less harmful.

Methods: Data were drawn from the 2017 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults. Logistic regression models were used to examine correlates of the belief that "organic" or "additive-free" tobacco products are less harmful than regular tobacco products.

Results: Overall, 26.7% of US adults and 45.3% of adult smokers believe that "organic" tobacco products are less harmful than regular tobacco products. Similarly, 35.2% of US adults and 47.1% of smokers believe that "additive-free" tobacco products are less harmful. When examining gender, age, education, race/ethnicity, sexual orientation, and smoking status, only age (adjusted odds ratio [aOR] ~0.98, 95% confidence interval [CI]: 0.97, 0.99 for both outcomes) and smoking status (current vs. never smokers, aOR ~1.78, 95% CI 1.03, 3.07 for both outcomes) were correlates of believing that "organic" or "additive-free" tobacco is less harmful than regular tobacco products.

Conclusions: Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread. Younger adults and current smokers are most likely to be misinformed by "organic" or "additive-free" tobacco product descriptors.

Implications: Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread among US adults and most prevalent among smokers. Removal of terms that incorrectly imply reduced harm may correct current and future consumers' misperceptions about the brand.
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http://dx.doi.org/10.1093/ntr/ntz015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775854PMC
June 2019

Longitudinal e-Cigarette and Cigarette Use Among US Youth in the PATH Study (2013-2015).

J Natl Cancer Inst 2019 10;111(10):1088-1096

Background: Evidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking.

Methods: Our analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013-2014; Wave 2 [W2] 2014-2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided.

Results: In weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P < .001); W1 ever-ENDS use did not affect change in cigarette frequency at W2 (n = 1020, beta = 0.31, 95% CI = -0.76 to 1.39, P = .57); 1-5 days ENDS use compared with ever, no past-30-day ENDS use was associated with a statistically significant decrease of W2 smoking days (n = 256, beta = -2.64, 95% CI = -4.96 to -0.32; P = .03); and W1 6+ day ENDS users did not show a decrease in frequency of cigarette smoking.

Conclusions: Ever-ENDS use predicts future cigarette smoking, and frequency of ENDS use has a differential impact on subsequent cigarette smoking uptake or reduction. These results suggest that both cigarettes and ENDS should be targeted in early tobacco prevention efforts with youth.
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http://dx.doi.org/10.1093/jnci/djz006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6792095PMC
October 2019
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