Publications by authors named "Shyanika W Rose"

46 Publications

Image Processing for Public Health Surveillance of Tobacco Point-of-Sale Advertising: Machine Learning-Based Methodology.

J Med Internet Res 2021 Aug 27;23(8):e24408. Epub 2021 Aug 27.

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

Background: With a rapidly evolving tobacco retail environment, it is increasingly necessary to understand the point-of-sale (POS) advertising environment as part of tobacco surveillance and control. Advances in machine learning and image processing suggest the ability for more efficient and nuanced data capture than previously available.

Objective: The study aims to use machine learning algorithms to discover the presence of tobacco advertising in photographs of tobacco POS advertising and their location in the photograph.

Methods: We first collected images of the interiors of tobacco retailers in West Virginia and the District of Columbia during 2016 and 2018. The clearest photographs were selected and used to create a training and test data set. We then used a pretrained image classification network model, Inception V3, to discover the presence of tobacco logos and a unified object detection system, You Only Look Once V3, to identify logo locations.

Results: Our model was successful in identifying the presence of advertising within images, with a classification accuracy of over 75% for 8 of the 42 brands. Discovering the location of logos within a given photograph was more challenging because of the relatively small training data set, resulting in a mean average precision score of 0.72 and an intersection over union score of 0.62.

Conclusions: Our research provides preliminary evidence for a novel methodological approach that tobacco researchers and other public health practitioners can apply in the collection and processing of data for tobacco or other POS surveillance efforts. The resulting surveillance information can inform policy adoption, implementation, and enforcement. Limitations notwithstanding, our analysis shows the promise of using machine learning as part of a suite of tools to understand the tobacco retail environment, make policy recommendations, and design public health interventions at the municipal or other jurisdictional scale.
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http://dx.doi.org/10.2196/24408DOI Listing
August 2021

Real-Time Context of Tobacco Marketing Exposure and Community Vulnerability-An Ecological Momentary Assessment Among Young Adults.

Ann Behav Med 2021 Jul 29. Epub 2021 Jul 29.

Center for Health Equity Transformation, Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA.

Background: Exposure to tobacco product marketing increases tobacco use among young adults, especially those from vulnerable communities (VCs).

Purpose: This study examined real-time tobacco marketing exposure among young adults from vulnerable and non-vulnerable communities using Ecological Momentary Assessment (EMA).

Methods: This study used EMA data to assess context (e.g., location and activity) of tobacco marketing exposure using four text-messaging surveys per day over 2 weeks. Young adult non-current tobacco users living in Washington, D.C. (n = 146; ages 18-24) recorded 5,285 surveys, including 20 participants (13.2%) from VCs with high proportions of lower income and racial/ethnic minorities, and high smoking rates. Unadjusted and adjusted multilevel logistic regressions were used to assess the associations between exposure to any and flavored tobacco marketing, VC residence, and real-time context.

Results: Fifty-nine participants (40.4%) reported at least one tobacco marketing exposure and recorded 94 exposure moments. In adjusted models, odds of exposure were higher among VC residents (AOR = 2.6, 95% CI = 1.2-5.4), in the presence of anyone using tobacco versus no use (AOR = 4.0, 95% CI = 2.4-6.7), at store/retail (AOR = 17.0, 95% CI = 6.4-44.8), or outside/in transit (AOR = 4.1, 95% CI = 2.1-7.8) versus at home. VC residence (AOR = 7.2, 95% CI = 2.3-22.2) was the strongest predictor of flavored tobacco marketing exposure among all covariates examined.

Conclusions: Young adults are predominantly exposed to tobacco marketing in their daily lives through retail advertisements. Young adults from VCs are at increased risks of seeing any tobacco and especially flavored tobacco marketing. Policies that curtail tobacco retailer density and advertisement displays may reduce overall and differential tobacco marketing exposure.
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http://dx.doi.org/10.1093/abm/kaab066DOI Listing
July 2021

Oral nicotine marketing claims in direct-mail advertising.

Tob Control 2021 May 6. Epub 2021 May 6.

Behavioral Sciences, University of Kentucky College of Medicine, Lexington, KY, USA.

Background: Little is known regarding how oral nicotine products (eg, nicotine pouches, lozenges) are marketed to consumers, including whether potential implicit reduced harm claims are used. In the current study, we explored the marketing claims present in a sample of direct-mail oral nicotine advertisements sent to US consumers (March 2018-August 2020).

Methods: Direct-mail ads (n=50) were acquired from Mintel and dual-coded for the following claims: alternative to other tobacco products, ability to use anywhere, spit-free, smoke-free and product does not contain tobacco leaf. We merged the coded data with Mintel's volume estimate (number of mail pieces sent to consumers) and calculated the proportion of oral nicotine advertisements containing claims by category.

Results: Of the 38 million pieces of oral nicotine direct-mail sent to US consumers, most featured claims that the product could be used anywhere (84%, 31.8 million pieces); was an alternative to other tobacco products (69%, 26.1 million pieces); and did not contain tobacco leaf (eg, 'tobacco leaf-free', 'simple' approach of extracting nicotine from tobacco; 55%, 20.7 million pieces). A slightly smaller proportion contained claims that oral nicotine was 'spit-free' (52%, 19.8 million pieces) or 'smoke-free' (31%, 11.7 million pieces).

Conclusion: Our results provide an early indication of marketing claims used to promote oral nicotine. The strategies documented, particularly the use of language to highlight oral nicotine is tobacco-free, may covey these products as lower-risk to consumers despite the lack of evidence or proper federal authorisation that oral nicotine products are a . Future research is needed to examine consumer perceptions of such claims.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056446DOI Listing
May 2021

Twitter Discourse on Nicotine as Potential Prophylactic or Therapeutic for COVID-19.

medRxiv 2021 Jan 6. Epub 2021 Jan 6.

Center for Health Equity Transformation and Department of Behavioral Science, College of Medicine, Lexington, KY.

Objective: The low observed prevalence of smokers among hospitalized COVID-19 patients in certain cohorts has led to a hypothesis regarding nicotine's therapeutic role in COVID-19 prevention and treatment. As new scientific evidence surfaces, premature conclusions about nicotine are rife in social media, especially unwarranted leaps of such associations to vaping and smoking. This study reports on the prevalence of such leaps and the nature of authors who are making them.

Methods: We used a Twitter API subscription service to download tweets (n = 17,533) that match terms indicating nicotine or vaping themes, in addition to those that point to a prophylactic or therapeutic effect and COVID-19 (January-July 2020). Using a windowing approach, we focused on tweets that are more likely to convey the therapeutic intent. We hand-annotated these filtered tweets and built a classifier that identifies tweets that extrapolate a nicotine link to vaping/smoking. We analyzed the frequently used terms in author bios, top Web links, and hashtags of such tweets.

Results: 21% of our filtered tweets indicate a vaping/smoking-based prevention/treatment narrative. Our classifier was able to spot tweets that make unproven claims about vaping/smoking and COVID-19 with a positive predictive value of 85%. Qualitative analyses show a variety of ways therapeutic claims are being made and user bios reveal pre-existing notions of positive stances toward vaping.

Conclusion: The social media landscape is a double-edged sword in tobacco communication. Although it increases information reach, consumers can also be subject to confirmation bias when exposed to inadvertent or deliberate framing of scientific discourse that may border on misinformation. This calls for circumspection and additional planning in countering such narratives as the COVID-19 pandemic continues to ravage our world.
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http://dx.doi.org/10.1101/2021.01.05.21249284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805473PMC
January 2021

Cigar-Smoking Patterns by Race/Ethnicity and Cigar Type: A Nationally Representative Survey Among U.S. Adults.

Am J Prev Med 2021 01;60(1):87-94

Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, Maryland.

Introduction: Racial/ethnic minorities have a higher prevalence of past 30-day cigar smoking than White, non-Hispanics. Little is known, however, about racial/ethnic differences in advanced cigar-smoking patterns by cigar types. This research explores whether cigar-smoking patterns differ by race/ethnicity and cigar types.

Methods: This study used a nationally representative sample of adults (aged ≥18 years; N=28,148) from the Wave 3 survey (2015-2016) of the Population Assessment of Tobacco and Health Study for analysis. Cigar-smoking patterns included past 30-day use, daily use, established use, past 12-month blunt use, use within 30 minutes of waking, and the number of cigars used per day. Weighted multivariable regressions were conducted in 2019 to examine the associations between race/ethnicity and cigar-smoking patterns by cigar types (traditional cigars, cigarillos, and filtered cigars), controlling for covariates.

Results: Compared with White, non-Hispanics, Black, non-Hispanics were more likely to smoke cigars in the past 30 days (AOR=2.27, 95% CI=2.03, 2.54) and daily (AOR=2.65, 95% CI=1.89, 3.70), have established cigar smoking (AOR=1.95, 95% CI=1.66, 2.29), and smoke blunts in the past 12 months (AOR=2.30, 95% CI=1.84, 2.88). This pattern was generally consistent across cigar types and was especially pronounced for cigarillos. Compared with White, non-Hispanics, Hispanics were more likely to smoke cigars within 30 minutes of waking (AOR=1.50, 95% CI=1.10, 2.06).

Conclusions: This study finds that Black, non-Hispanics and Hispanics have more advanced patterns of cigar smoking than White, non-Hispanics. Interventions and policies for minimizing cigar smoking may differentially benefit these populations and reduce disparities.
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http://dx.doi.org/10.1016/j.amepre.2020.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755027PMC
January 2021

Going Smokeless: Promotional Features and Reach of US Smokeless Tobacco Direct-Mail Advertising (July 2017-August 2018).

Nicotine Tob Res 2021 08;23(8):1349-1357

Truth Initiative Schroeder Institute, Washington, DC.

Introduction: Although cigarette use in the United States has declined over time, smokeless tobacco (SLT) use has remained steady. Direct-mail advertising and coupon redemption have been linked to increased tobacco use, and efforts to promote SLT through direct-mail advertising may contribute to sustained SLT use. We examined reach of SLT direct-mail advertisements by recipient demographics and promotional features, including coupons.

Methods: Direct-mail data (n = 418) were acquired from Comperemedia (Mintel) and coded for product type (traditional [eg, chewing tobacco], pouched [eg, moist snuff, snus], or both [traditional SLT and any pouched SLT products]); promotions (eg, coupons); flavors; and themes (eg, masculinity). Using Mintel's volume estimates for number of pieces sent, we calculated the proportion of mail volume sent by recipient demographics (age, income, region) and advertising features across product type.

Results: Between July 2017 and August 2018, tobacco companies sent an estimated 249 million pieces of SLT direct-mail to US households; approximately half (49.6%) featured pouched SLT products. Across product types, over 75% of mail volume was sent to 31- to 60-year-old adults and 30-40% was sent to low-income households. The majority (>70%) of pouched SLT product mail contained coupons and flavor promotions. Outdoor and blue-collar-lifestyle themes were prominent in advertisements for all product types, along with less common adventure- and fun-related appeals.

Conclusions: Coupons, flavors, and a combination of blue-collar and fun/adventure message themes were used to promote traditional and pouched SLT products through direct-mail, particularly to low-income households. Results support limits on direct-mail coupon distribution and continued surveillance of marketing appeals.

Implications: There is a long history of research into tobacco advertising practices, largely focusing on cigarettes. This study highlights specific direct-mail marketing tactics used by the tobacco industry, including coupons to promote SLT products across the United States. Given the limited success in reducing SLT use and the association between direct-mail promotions and tobacco use, these study results provide support for policies to restrict use of coupons in direct-to-consumer tobacco marketing and indicate the need for continued surveillance of direct-mail advertisements as the SLT market continues to evolve.
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http://dx.doi.org/10.1093/ntr/ntaa255DOI Listing
August 2021

Modelling retailer-based exemptions in flavoured tobacco sales restrictions: national estimates on the impact of product availability.

BMJ Open 2020 11 26;10(11):e040490. Epub 2020 Nov 26.

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

Objectives: More than 250 US localities restrict sales of flavoured tobacco products (FTPs), but comprehensiveness varies, and many include retailer-based exemptions. The purpose of this study is to examine resulting changes in the US retail environment for FTPs if there was a hypothetical national tobacco control policy that would prohibit FTP sales in all retailers except (1) tobacco specialty stores or (2) tobacco specialty stores and alcohol outlets.

Design And Setting: A cross-sectional analysis of the FTP retail environment in every US Census tract (n=74 133). FTP retailers (n=3 10 090) were enumerated using nine unique codes from a national business directory (n=296 716) and a national vape shop directory (n=13 374).

Outcome Measures: We assessed FTP availability using static-bandwidth and adaptive-bandwidth kernel density estimation. We then calculated the proportion of FTP stores remaining and the mean density of FTP retailers under each policy scenario for the overall population, as well as across populations vulnerable to FTP use.

Results: Exempting tobacco specialty stores alone would leave 25 276 (8.2%) FTP retailers nationwide, while exempting both tobacco specialty stores and alcohol outlets would leave 54 091 (17.4%) retailers. On average, the per cent remaining FTP availability per 100 000 total population was 7.1% for a tobacco specialty store exemption and 18.1% for a tobacco specialty store and alcohol outlet exemption. Overall, density estimate trends for remaining FTP availability among racial/ethnic populations averaged across Census tracts mirrored total population density. However, estimates varied when stratified by metropolitan status. Compared with the national average, FTP availability would remain 47%-49% higher for all racial/ethnic groups in large metropolitan areas.

Conclusions: Retailer-based exemptions allow greater FTP availability compared with comprehensive policies which would reduce FTP availability to zero. Strong public policies have the greatest potential impact on reducing FTP availability, particularly among urban, and racial/ethnic minority populations.
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http://dx.doi.org/10.1136/bmjopen-2020-040490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692830PMC
November 2020

National Support for a Menthol Cigarette Sales Ban.

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

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

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

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

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

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

Perceptions of E-cigarettes and Flavor Restrictions among Tobacco Retailers in Los Angeles.

Am J Health Behav 2020 11;44(6):893-901

Lourdes Baezconde-Garbanati, University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA, United States.

In this study, we examined tobacco retailers' perceptions of e-cigarettes and associations with in-store availability of e-cigarettes. Retailers (N = 700) in multiple, racial/ethnic neighborhoods (black/African-American, N = 200); Hispanic/Latino, N = 200; white American, N = 200; Korean American, N = 100) in Los Angeles County participated in on-site interviews and store observations. Controlling for individual and racial/ethnic neighborhood factors, retailers in majority-white neighborhoods had significantly higher odds of selling e-cigarettes and flavored e-cigarettes than retailers located in Hispanic/Latino (p < .001, OR = 0.14, 95% CI = 0.08-0.25; p < .001, OR = 0.19, 95% CI = 0.11-0.33) and Korean American (p < .05, OR = 0.21, 95% CI = 0.12-0.37; p < .05, OR = 0.21, 95% CI = 0.12-0.39) neighborhoods. Perceptions of e-cigarettes as being completely safe/safer than cigarettes were significantly associated with availability of flavored e-cigarettes (p < .05, OR = 2.03, 95% CI = 1.04-3.97); and opposition to flavored e-cigarette restrictions was marginally significantly associated with availability of flavored e-cigarettes (p < .10, OR = 1.56, 95% CI = 0.96-2.51). Adjusting for store type, perceptions of e-cigarettes as being completely safe/safer than cigarettes were marginally significantly associated with availability of flavored e-cigarettes (p < .10, OR = 1.78, 95% CI = 0.85-3.73). : Targeted efforts are warranted for educating retailers and employees in these neighborhoods on the appeal and nicotine dependence potential of e-cigarette use for youth.
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http://dx.doi.org/10.5993/AJHB.44.6.12DOI Listing
November 2020

Convenience Store Access and E-cigarette Advertising Exposure Is Associated With Future E-cigarette Initiation Among Tobacco-Naïve Youth in the PATH Study (2013-2016).

J Adolesc Health 2021 04 7;68(4):794-800. Epub 2020 Oct 7.

College of Medicine, Department of Behavioral Science, and Center for Health Equity Transformation, University of Kentucky, Lexington, Kentucky; Markey Cancer Center, Lexington, Kentucky.

Purpose: The association between e-cigarette marketing exposure and youth e-cigarette initiation is not well understood. This study examines whether convenience store access, exposure to retail e-cigarette marketing, and having a favorite e-cigarette ad before e-cigarette use is associated with susceptibility to use and future e-cigarette initiation in a national longitudinal study of youth.

Methods: A nationally representative longitudinal cohort of youth in the Population Assessment of Tobacco and Health study (12-17 years) was followed up over three waves of annual data collection (2013-2016). Tobacco-naïve (wave 1) and e-cigarette-naïve (wave 2) youth (n = 6,470) were included. Marketing exposure at wave 2 was examined in association with e-cigarette susceptibility (wave 2) and e-cigarette initiation (wave 3) using adjusted logistic regression models. Analysis occurred in 2019.

Results: Youth visiting convenience stores at least weekly (vs. never) had 1.51 times the odds of e-cigarette susceptibility (95% confidence interval [CI]: 1.25, 1.81) and 1.79 times the odds of e-cigarette initiation (95% CI: 1.29, 2.48). Noticing a retail e-cigarette ad (vs. not noticing) was associated with e-cigarette susceptibility (adjusted odds ratio [AOR] 1.36, 95% CI: 1.18, 1.57), but not initiation. Youth reporting a favorite branded e-cigarette ad had greater odds of both susceptibility (AOR 1.31, 95% CI, 1.10, 1.56) and e-cigarette initiation (AOR 1.60, 95% CI: 1.18, 2.17) compared to youth without a favorite ad.

Conclusions: Tobacco-naïve youth with frequent convenience store access and exposure to e-cigarette marketing were at greater risk of e-cigarette susceptibility and progression to e-cigarette initiation over a 2-year period. Policies to restrict retailer locations and e-cigarette marketing could enhance youth e-cigarette use prevention efforts.
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http://dx.doi.org/10.1016/j.jadohealth.2020.08.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317228PMC
April 2021

E-cigarette availability, price promotions and marketing at the point-of sale in the contiguous United States (2014-2015): National estimates and multilevel correlates.

Prev Med Rep 2020 Sep 26;19:101152. Epub 2020 Jun 26.

Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA.

Electronic cigarette (e-cigarette) sales and use have increased rapidly, yet point-of-sale e-cigarette availability and marketing is understudied. We estimated changes in e-cigarette availability and marketing among tobacco retailers in the U.S., and associations with neighborhood characteristics. A national sample of tobacco retailers in the Contiguous U.S. was audited in 2014 and 2015 (n = 1,905 and n = 2,126, respectively) to observe e-cigarette availability and marketing (signs, ads, displays and promotions) and generate national prevalence estimates. Store, neighborhood and state level correlates of 2015 e-cigarette availability, price promotions and exterior advertising were analyzed using multilevel mixed-effects generalized linear models. E-cigarettes were sold at 72.0% of retailers in 2014 and at 79.2% in 2015. Price promotions increased from 11.9% to 20.2% of retailers. Among retailers that did not previously sell e-cigarettes in 2012, availability in 2015 was greater for retailers in neighborhoods with the highest proportion of Black residents (vs. lowest). E-cigarette price promotions were more prevalent in neighborhoods with more Hispanic residents, while exterior e-cigarette marketing was more prevalent in neighborhoods with more Black residents. State smoking prevalence was positively associated with e-cigarette availability, promotions and advertising. E-cigarette point-of-sale availability and marketing increased between 2014 and 2015 and expanded to neighborhoods with a higher proportion of Black residents between 2012 and 2015. Retailers located within states with high smoking prevalence appear to be targeted by e-cigarette marketing. As e-cigarettes become the target of more regulations, understanding changes in the e-cigarette retail environment is critical to inform potential policies regulating their sale and marketing.
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http://dx.doi.org/10.1016/j.pmedr.2020.101152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338777PMC
September 2020

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

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

New York University, New York, NY, USA.

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

Characteristics and Reach Equity of Policies Restricting Flavored Tobacco Product Sales in the United States.

Health Promot Pract 2020 01;21(1_suppl):44S-53S

Truth Initiative Schroeder Institute, Washington, DC, USA.

In 2009, flavored cigarettes (except menthol) were banned in the United States, but other flavored tobacco products (FTPs) were allowed. Women, populations of color, youth, sexual minority, and low-socioeconomic status populations disproportionately use FTPs. Localities have passed sales restrictions on FTPs that may reduce disparities if vulnerable populations are reached. This study assessed the extent to which FTP restrictions reached these subgroups ("reach equity"). We identified 189 U.S. jurisdictions with FTP policies as of December 31, 2018. We linked jurisdictions with demographics of race/ethnicity, gender, age, partnered same-sex households and household poverty, and stratified by policy strength. We calculated Reach Ratios (ReRas) to assess reach equity among subgroups covered by FTP policies relative to their U.S. population representation. Flavor policies covered 6.3% of the U.S. population (20 million individuals) across seven states; 0.9% were covered by strong policies (12.7% of policies). ReRas indicated favorable reach equity to young adults, women, Hispanics, African Americans, Asians, partnered same-sex households, and those living below poverty. Youth, American Indians/Alaska Natives (AIAN) and Native Hawaiians/Pacific Islanders (NHPI) were underrepresented. Strong policies had favorable reach equity to young adults, those living below poverty, Asians, NHPIs, individuals of 2+ races, and partnered same-sex households, but unfavorable reach equity to women, youth, Hispanic, AIAN, and African American populations. U.S. flavor policies have greater reach to many, but not all, subgroups at risk of FTP use. Increased enactment of strong policies to populations not covered by flavor policies is warranted to ensure at-risk subgroups sufficiently benefit.
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http://dx.doi.org/10.1177/1524839919879928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988448PMC
January 2020

Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015.

JAMA Netw Open 2019 10 2;2(10):e1913804. Epub 2019 Oct 2.

Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, New York.

Importance: Flavors in tobacco products may appeal to young and inexperienced users.

Objective: To examine among youth (aged 12-17 years), young adults (aged 18-24 years), and adults (aged ≥25 years) the prevalence of first use of flavored tobacco products among new tobacco users and the association between first flavored use of a given tobacco product and tobacco use 1 year later, including progression of tobacco use.

Design, Setting, And Participants: This cohort study represents a longitudinal analysis of data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study with data collected in 2013 to 2014 (wave 1) and 2014 to 2015 (wave 2). Participants were noninstitutionalized individuals, including 11 996 youth and 26 447 adults, in selected households who participated in both waves of the PATH Study. Data analysis was conducted from July 2016 to June 2019.

Main Outcomes And Measures: Prevalence of tobacco product use at wave 2.

Results: The mean (SE) age of the participants was 14.5 (0.0) years for youth, 21.1 (0.0) years for young adults, and 50.3 (0.0) for adults. Most youth (71.9%; 95% CI, 69.7%-74.0%) and young adults (57.6%; 95% CI, 54.9%-60.3%) who were new users of tobacco products over the 10- to 13-month follow-up period used flavored products. First use of a menthol or mint or other flavored cigarette documented at wave 1 was positively associated with past 12-month and past 30-day cigarette use in all age groups at wave 2 compared with first use of a nonflavored cigarette (youth, flavored cigarette, past 12-month use adjusted prevalence ratio [aPR], 1.14 [95% CI, 1.05-1.25] and past 30-day use aPR, 1.15 [95% CI, 1.00-1.31]; youth, menthol or mint cigarette, past 12-month use aPR, 1.18 [95% CI, 1.08-1.29] and past 30-day use aPR, 1.19 [95% CI, 1.04-1.37]; young adult, flavored cigarette, past 12-month use aPR, 1.09 [95% CI, 1.04-1.15] and past 30-day use aPR, 1.13 [95% CI, 1.06-1.21]; young adult menthol or mint cigarette, past 12-month use aPR, 1.10 [95% CI, 1.05-1.16] and past 30-day use aPR, 1.15 [95% CI, 1.07-1.23]; adult flavored cigarette, past 12-month use aPR, 1.10 [95% CI, 1.05-1.15] and past 30-day use aPR, 1.09 [95% CI, 1.04-1.14]; adult menthol or mint cigarette, past 12-month use aPR, 1.13 [95% CI, 1.08-1.18] and past 30-day use aPR, 1.12 [95% CI, 1.07-1.17]). Among young adults, first use of flavored e-cigarettes (aPR, 2.05; 95% CI, 1.61-2.61), any cigars (aPR, 1.60; 95% CI, 1.26-2.02), cigarillos (aPR, 1.49; 95% CI, 1.08-2.05), filtered cigars (aPR, 3.69; 95% CI, 2.08-6.57), hookah (aPR, 1.91; 95% CI, 1.23-2.98), and any smokeless tobacco (aPR, 1.54; 95% CI, 1.08-2.20) was prospectively associated with current regular use of those products at wave 2 compared with first nonflavored use. Among adults aged 25 years and older, first use of flavored e-cigarettes (aPR, 1.60; 95% CI, 1.41-1.82), any cigars (aPR, 1.56; 95% CI, 1.29-1.87), cigarillos (aPR, 1.29; 95% CI, 1.01-1.64), filtered cigars (aPR, 1.79; 95% CI, 1.25-2.54), hookah (aPR, 5.66; 95% CI, 2.04-15.71), and any smokeless tobacco (aPR, 1.55; 95% CI, 1.32-1.82) was prospectively associated with current regular use of those products at wave 2 compared with first nonflavored use.

Conclusions And Relevance: In this longitudinal cohort study, flavors in tobacco products were associated with youth and young adult tobacco experimentation. First use of a flavored tobacco product may place youth, young adults, and adults at risk of subsequent tobacco use.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.13804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820032PMC
October 2019

Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature.

Tob Induc Dis 2019 18;17:68. Epub 2019 Sep 18.

Keck School of Medicine, University of Southern California, Los Angeles, United States.

Introduction: We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups.

Methods: Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group.

Results: There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results.

Conclusions: We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.
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http://dx.doi.org/10.18332/tid/111397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770621PMC
September 2019

Tobacco Industry Marketing Exposure and Commercial Tobacco Product Use Disparities among American Indians and Alaska Natives.

Subst Use Misuse 2020 23;55(2):261-270. Epub 2019 Sep 23.

Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA.

: Non-Hispanic American Indians and Alaska Natives (NH AI/AN) have the highest commercial tobacco use (CTU) among U.S. racial/ethnic groups. Tobacco marketing is a risk factor, however few studies examine it among NH AI/AN. : We identified prevalence of tobacco industry marketing exposure and correlates of CTU among NH AI/AN compared to other racial/ethnic groups. : Data were from wave 1 (2013-2014;  = 32,320) of the Population Assessment of Tobacco and Health Study, analyzing self-reported exposure to tobacco ads from stores, tobacco package displays, direct mail and email marketing. Correlates of CTU were identified and interactions between racial/ethnic groups and tobacco marketing were assessed. : NH AI/AN ( = 955) had a higher prevalence of exposure to retail tobacco ads (64.5% vs 59.3%;  < 0.05), mail (20.2% vs.14.3%;  < 0.001) and email (17.0% vs.10.6%;  < 0.001) marketing than NH Whites ( = 19,297). Adjusting for tobacco use and related risk factors, exposure to email marketing remained higher among NH AI/AN than NH Whites. Interactions between racial/ethnic groups and marketing exposures on CTU were nonsignificant. CTU was higher among NH AI/AN than NH Whites and among adults who reported exposure to tobacco ads, mail, and email marketing. : There is higher tobacco marketing exposure in stores and via mail for NH AI/AN. Email marketing exposure was higher, even after controlling for tobacco-related risk factors. The tobacco industry may be targeting NH AI/AN through emails, which include coupons and other marketing promotions. Culturally relevant strategies that counter-act tobacco industry direct marketing tactics are needed to reduce disparities in this population.
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http://dx.doi.org/10.1080/10826084.2019.1664589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980664PMC
October 2020

Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014-2015.

Tob Control 2020 07 21;29(4):432-446. Epub 2019 Sep 21.

Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA.

Background: Most youth and young adult (YA) tobacco users use flavoured products; however, little is known about specific flavours used.

Methods: We report flavour types among US tobacco users from the Population Assessment of Tobacco and Health Study, wave 2, 2014-2015. At wave 2, we examined (1) flavour use and type at past 30-day use; (2) new flavoured tobacco product use and type; (3) product-specific flavour patterns across youth (ages 12-17) (n=920), YA (18-24) (n=3726) and adult (25+) (n=10 346) past 30-day and new tobacco users and (4) concordance between self-coded and expert-coded brand flavour type among all adults (18+).

Results: Prevalence of flavoured tobacco product use was highest among youth, followed by YA and adult 25+ any tobacco users. Within each age group, flavoured use was greatest among hookah, e-cigarette and snus users. Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavour types at first and past 30-day use across age groups. For past 30-day use, all flavour types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and YAs, followed by adults 25+. Prevalence of menthol/mint use was high (over 50% youth, YAs; 76% adults 25+) and exhibited a positive age gradient overall, though the reverse for cigarettes. Brand-categorised and self-reported flavour use measures among adults 18+ were moderately to substantially concordant across most products.

Conclusions: Common flavours like menthol/mint, fruit and candy/sweet enhance appeal to young tobacco users. Information on flavour types used by product and age can inform tobacco flavour regulations to addess flavour appeal especially among youth.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462091PMC
July 2020

Longitudinal Response to Restrictions on Menthol Cigarettes Among Young Adult US Menthol Smokers, 2011-2016.

Am J Public Health 2019 10 15;109(10):1400-1403. Epub 2019 Aug 15.

At the time of the study, the authors were with the Truth Initiative Schroeder Institute, Washington, DC.

To examine responses to hypothetical restrictions on menthol cigarettes among young adult menthol smokers in the United States. We surveyed Truth Initiative Young Adult Cohort respondents 18 to 34 years of age every 6 months from December 2011 through October 2016. Menthol cigarette smokers (n = 806, n = 1963 observations) indicated their response if menthol cigarettes were unavailable. Weighted analyses accounting for repeated measures were used to estimate the prevalence and correlates of responses and trends over time. Overall, 23.5% of young adult menthol smokers said they would quit if menthol cigarettes were unavailable, with this response largely unchanged between 2011 and 2016. There was a significant increase in the switch to another tobacco product response (from 7.4% to 13.2%;  = .01) associated with current noncigarette use. In adjusted analyses, African Americans, women, those with less than a high school education, and those with any quit intention were more likely to say they would quit smoking. Increased intentions to switch products suggest the acceptability and availability of alternatives to menthol cigarette smokers. Menthol cigarette restrictions benefit vulnerable groups and those interested in quitting, but the availability of menthol in noncigarette products could limit benefits.
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http://dx.doi.org/10.2105/AJPH.2019.305207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6726504PMC
October 2019

Exposure to Multimedia Tobacco Marketing and Product Use Among Youth: A Longitudinal Analysis.

Nicotine Tob Res 2020 05;22(6):1036-1040

Truth Initiative Schroeder Institute, Washington, DC.

Introduction: Tobacco companies continue to reach youth through direct-to-consumer marketing, which has been associated with overall tobacco use. We examine how exposure to these marketing activities influences product-specific use behaviors.

Methods: We analyzed data from 10 081 youth (aged 12-18 years) who participated in Waves 1 and 2 (2013-2015) of the Population Assessment of Tobacco and Health (PATH) Study. Participants reported past 6-month tobacco coupon receipt and online tobacco marketing engagement, and susceptibility to ever and current use of cigarette, e-cigarettes, cigars, smokeless tobacco, and hookah. Weighted multivariable logistic regression examined Wave 1 predictors of coupon receipt at Wave 2, and associations between coupon receipt, online engagement, and past 30-day use of different tobacco products.

Results: Youth received tobacco coupons at one (9.7%) or both waves (1.2%) and 11.1% engaged with online tobacco marketing. Coupon receipt and online marketing engagement at Wave 1 predicted Wave 2 coupon receipt among susceptible-never, ever-but-not-current, and current tobacco users (p < .05). Coupon receipt and online engagement at Wave 1 was positively associated with past 30-day use of cigarettes, e-cigarettes, cigars, smokeless tobacco, and hookah at Wave 2 (p < .05). The relationships were stronger for those who received coupons at both waves or engaged with more sources of online marketing.

Conclusions: Tobacco direct-to-consumer marketing is reaching youth. Repeated exposure to these marketing activities within and across media is associated with use of different tobacco products. New policies and strong enforcement of existing regulations prohibiting these illegal marketing tactics are critical to protect youth from future tobacco use.

Implications: Tobacco companies utilize coupons and online engagement activities to increase brand awareness, knowledge, and sales of their products. These kinds of marketing activities can be influential among youth at a time when they may develop tobacco use behaviors. Our findings suggest that tobacco companies may be targeting at-risk youth through cross-media marketing activities. The findings also indicate that exposure to these marketing activities predicts subsequent use of different tobacco products, with suggestive dose-response relationships. Increased regulations are needed to protect youth from these marketing activities.
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http://dx.doi.org/10.1093/ntr/ntz096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395665PMC
May 2020

Health claims made in vape shops: an observational study and content analysis.

Tob Control 2019 12 23;28(e2):e119-e125. Epub 2019 May 23.

Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Background: Prior to the final deeming rule, federal law in the USA prohibited electronic cigarettes (e-cigarettes) from being marketed as smoking cessation products; for other therapeutic purposes and in ways that conveyed Food and Drug Administration (FDA) approval/endorsement. After August 2016, additional federal prohibitions were added including false/misleading and unauthorised modified risk tobacco product (MRTP) claims. No systematic investigation of e-cigarette health claims has been conducted in the retail environment. We sought to document and characterise claims made in vape shops.

Methods: Between November 2015 and February 2016, before final deeming rule implementation, two trained data collectors conducted unannounced observational assessments of 46 vape shops in North Carolina. Data collectors used wearable imaging technology to document health claims about e-cigarettes. Photos were coded for five claim types: (1) cessation device; (2) drug effect/device; (3) FDA-approved/endorsed; (4) false/misleading and (5) MRTP. Photos were double coded; differences between coders were adjudicated and reviewed by an expert panel.

Results: At least one health claim was displayed in 41.3% (n=19) of retailers, ranging from 0 to 27 claims per retailer. All claim types were found. Cessation device claims were the most prevalent (62.2%, n=84), followed by MRTP (27.4%, n=37), drug effect/device (8.1%, n=11), false/misleading (1.5%, n=2), and FDA approved/endorsed (0.7%, n=1). Retail chains made the majority of claims compared with independent shops (88.9% vs 11.1%).

Conclusions: Many vape shops displayed e-cigarette health claims, which are all now FDA prohibited. These claims could mislead consumers and influence behaviour. Findings highlight the need for retailer education, continued surveillance, enforcement specific to advertising and research on consumer perceptions of claims.
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http://dx.doi.org/10.1136/tobaccocontrol-2018-054537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142343PMC
December 2019

Menthol Smoking Patterns and Smoking Perceptions Among Youth: Findings From the Population Assessment of Tobacco and Health Study.

Am J Prev Med 2019 04;56(4):e107-e116

Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Introduction: Youth may be attracted to menthol cigarettes because they are perceived as less harmful and harsh to smoke relative to non-menthol cigarettes. This study examined demographic factors and menthol cigarette smoking patterns as correlates of youth harm perceptions of cigarette smoking and ease of smoking menthol versus non-menthol cigarettes.

Methods: Data were from the Wave 1 (2013-2014) youth sample of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regression models were used to examine correlations between demographic factors and menthol cigarette smoking patterns (menthol initiation, past 30-day menthol cigarette smoking, and menthol cigarette brand preference), with harm perceptions of cigarette smoking and ease of smoking a menthol cigarette.

Results: Nearly half of ever cigarette smoking youth (43%) first used a menthol cigarette; 21% reported past 30-day menthol cigarette smoking; and 42% of past 30-day smokers providing brand information used a menthol cigarette as their preferred brand. In bivariate analyses, initiation with a menthol cigarette and menthol brand preference (versus non-menthol) were correlated with black race, older age at initiation, and past 30-day menthol cigarette smoking. In adjusted models, past 30-day menthol cigarette smoking and menthol cigarette brand preference, but not menthol initiation, were correlated with the perception that menthol cigarettes are easier to smoke.

Conclusions: Youth who smoke menthol cigarettes perceive them as easier to smoke, even after adjusting for other factors. Age of initiation and black race emerged as correlates of menthol cigarette initiation, brand preference, and cigarette harm perceptions, and may inform future prevention campaigns.
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http://dx.doi.org/10.1016/j.amepre.2018.11.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453836PMC
April 2019

Tobacco Advertisement Liking, Vulnerability Factors, and Tobacco Use Among Young Adults.

Nicotine Tob Res 2019 02;21(3):300-308

Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Introduction: Young adulthood (aged 18-24) is a crucial period in the development of long-term tobacco use patterns. Tobacco advertising and promotion lead to the initiation and continuation of smoking among young adults. We examined whether vulnerability factors moderated the association between tobacco advertisement liking and tobacco use in the United States.

Methods: Analyses were conducted among 9109 US young adults in the nationally representative Population Assessment of Tobacco and Health (PATH) Study wave 1 (2013-14). Participants viewed 20 randomly selected sets of tobacco advertisements (five each for cigarettes, e-cigarettes, cigars, and smokeless tobacco) and indicated whether they liked each ad. The outcome variables were past 30-day cigarette, e-cigarette, cigar, and smokeless tobacco use. Covariates included tobacco advertisement liking, age, sex, race or ethnicity, sexual orientation, education, poverty level, military service, and internalizing and externalizing mental health symptoms.

Results: Liking tobacco advertisements was associated with tobacco use, and this association was particularly strong among those with lower educational attainment (cigarettes, cigars) and living below the poverty level (e-cigarettes, smokeless tobacco).

Conclusions: The association between tobacco advertisement liking and tobacco use was stronger among young adults with lower educational attainment and those living below the poverty level. Policies that restrict advertising exposure and promote counter-marketing messages in this population could reduce their risk.

Implications: This study shows that liking tobacco advertisements is associated with current tobacco use among young adults, with stronger associations for vulnerable young adults (ie, lower education levels and living below the poverty level). Findings suggest a need for counter-marketing messages, policies that restrict advertising exposure, and educational interventions such as health and media literacy interventions to address the negative influences of tobacco advertisements, especially among young adults with a high school education or less and those living below the poverty level.
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http://dx.doi.org/10.1093/ntr/nty220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611945PMC
February 2019

Population-level patterns and mental health and substance use correlates of alcohol, marijuana, and tobacco use and co-use in US young adults and adults: Results from the population assessment for tobacco and health.

Am J Addict 2018 09;27(6):491-500

Department of Oncology, Georgetown University Medical Center, Washington, DC, District of Columbia.

Background And Objectives: This study identified the most common patterns of current alcohol and marijuana use with the spectrum of tobacco products (cigarettes, hookah, e-cigarettes, cigars/little cigars, and other products), among US young adults and older adults and examined associations of mental health and substance use problems with each pattern.

Methods: Wave 1 adult dataset (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses estimated the prevalence of the top 10 patterns of current alcohol, marijuana, and tobacco use and co-use separately by young adults aged 18-24 (n = 9,112) and adults 25+ years (n = 23,208). Multivariable models examined associations of substance use and mental health problems to patterns of use, adjusting for demographics.

Results: Across both age groups, alcohol-only use was the most popular use pattern (20.7% for young adults and 32.2% older adults) however poly-substance use patterns were more frequent than single use patterns. Cigarettes were the only tobacco product used exclusively; all other tobacco products were used with together, or with alcohol or marijuana. Only one young adult pattern emerged containing e-cigarettes, and this pattern included co-use with alcohol and cigarettes (1.3%). Mental health and substance use problems were most strongly correlated with dual and poly-substance use patterns, regardless of age.

Scientific Significance: Prevention and intervention campaigns should focus on multiple product use, as single substance use is uncommon. Alcohol is common in all patterns, suggesting it should also gain more focus in marijuana and tobacco prevention and intervention programs. (Am J Addict 2018;27:491-500).
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http://dx.doi.org/10.1111/ajad.12766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467268PMC
September 2018

The Association Between Menthol Perceptions and Support for a Policy Ban Among US Smokers.

Ethn Dis 2018 12;28(3):177-186. Epub 2018 Jul 12.

Schroeder Institute at Truth Initiative, Washington, DC.

Objective: To examine the relationship between menthol perceptions and support for a national menthol ban.

Participants: Data were collected from a nationally representative probability-based panel of adults aged ≥18 years during June 21, 2016 through July 18, 2016. A total of 1,303 respondents, including an oversample of 300 African Americans, completed the survey.

Main Outcome Measures: Weighted logistic regression models examined the relationship between menthol perceptions, specifically related to health and addiction, and the outcome measure: support for a menthol ban, by menthol smoking status. All models controlled for age, sex, education level, and race/ethnicity.

Results: The association between reporting accurate menthol health perceptions differed by menthol preference. Among non-menthol smokers, there was no association between accurate menthol health perceptions and support of a menthol ban while more accurate menthol perceptions of addiction were associated with greater support of a menthol ban (aOR=2.83, CI=1.19-6.72). Among menthol smokers, more accurate health-related menthol perceptions were associated with increased odds of supporting a menthol ban (aOR=3.90, CI=1.02-14.79) while more accurate menthol addiction perceptions were not.

Conclusions: Fewer current menthol smokers support a menthol ban than current non-menthol smokers given its effect on their preferred product. Given the large proportions of smokers who have misperceptions of the health consequences and addictive properties of menthol, there is a moral imperative to inform those who use these products. Findings suggest the need for tailored messaging strategies targeted to reach menthol smokers who will be most impacted by a ban, but also have the most to gain from such a policy change.
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http://dx.doi.org/10.18865/ed.28.3.177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051512PMC
October 2019

Adolescent tobacco coupon receipt, vulnerability characteristics and subsequent tobacco use: analysis of PATH Study, Waves 1 and 2.

Tob Control 2018 07 22;27(e1):e50-e56. Epub 2018 Feb 22.

Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Objectives: We examine adolescent receipt of tobacco coupons and subsequent tobacco use.

Methods: Data were from the Population Assessment of Tobacco and Health (PATH) Study (2013-2015). We identified correlates of coupon receipt at Wave 1 (youth sample age 12-17 ; n = 13 651) including demographics, additional vulnerability factors that may place youth at risk of tobacco use and correlates of coupon receipt by channel. We examined associations of Wave 1 coupon receipt with Wave 2 tobacco use using weighted multivariable models.

Results: Overall, 7.6% of US youth received tobacco coupons in the 6 months before Wave 1. Coupon recipients were more likely to be women, living outside urban areas, living with a tobacco user, current and former (vs never) tobacco users, having high internalising mental health symptoms and having a favourite tobacco advertisement. Coupons were received primarily through direct mail (56%), product packs (28%) and online (25%). Never tobacco users at Wave 1 who received coupons were more likely to be ever users at Wave 2 (adjusted OR (aOR)=1.42; 95% CI 1.06 to 1.91). Coupon recipients were more likely to use a new tobacco product between waves (aOR=1.67; 95% CI 1.18 to 2.36) and report past 30-day tobacco use at Wave 2 (aOR=1.81; 95% CI 1.31 to 2.49).

Conclusions: One in 13 US youth (7.6%) received coupons. Vulnerable youth had the greatest odds of coupon receipt. Coupon recipients had greater odds of tobacco use among never users, trying a new tobacco product and current use. Coupon bans, limits on youth coupon exposure, stronger age verification, pack inserts or restricting coupon redemption may help reduce tobacco use among adolescents, particularly for those at greatest risk.
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http://dx.doi.org/10.1136/tobaccocontrol-2017-054141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371970PMC
July 2018

Swisher Sweets 'Artist Project': using musical events to promote cigars.

Tob Control 2018 07 8;27(e1):e93-e95. Epub 2018 Feb 8.

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

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http://dx.doi.org/10.1136/tobaccocontrol-2017-054047DOI Listing
July 2018

Perceived racial/ethnic discrimination, marketing, and substance use among young adults.

J Ethn Subst Abuse 2019 Oct-Dec;18(4):558-577. Epub 2018 Feb 9.

Battelle Memorial Institute , Arlington , Virginia.

Perceived experiences of discrimination have been linked to negative health behaviors including tobacco, alcohol, and marijuana use across various racial/ethnic groups. Tobacco and alcohol marketing exposure have also been linked with substance use. This study examined the independent and interacting effects of perceived experiences of discrimination and exposure to alcohol and tobacco marketing, and receptivity to marijuana marketing on substance use in an online survey of a multiethnic sample of young adults in 6 metropolitan areas ( = 505). African Americans (mean () = 1.96, 9% 5CI [1.84, 2.09]) and Hispanics ( = 1.98, 95% CI [1.87, 2.09]) reported higher levels of perceived discrimination than Whites ( = 1.52, 95% CI [1.40, 1.64]),  <  .001. African Americans had higher levels of exposure to tobacco and alcohol marketing; Hispanics reported higher levels of exposure to alcohol marketing and receptivity to marijuana promotion. Discrimination and marketing exposure were independently associated with higher odds of all 3 outcomes, controlling for covariates (AOR from 2.1 to 3.4 for discrimination; AOR from 1.4 to 13.8 for marketing). Models showed a significant interaction of discrimination and tobacco marketing on past 30-day cigarette use (F = 5.5;  = .02). Individuals with high levels of tobacco marketing exposure were likely to report high past 30-day cigarette use regardless of level of discrimination, while those with low exposure were only at increased risk of reporting cigarette use at higher levels of discrimination. Both perceived discrimination and marketing exposure play a role in substance use. Interventions should consider discrimination as a significant risk factor underlying vulnerability to substance use among young adults.
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http://dx.doi.org/10.1080/15332640.2018.1425949DOI Listing
July 2020

Harm Perceptions of Menthol and Nonmenthol Cigarettes Differ by Brand, Race/Ethnicity, and Gender in US Adult Smokers: Results from PATH Wave 1.

Nicotine Tob Res 2019 03;21(4):439-449

Battelle Memorial Institute, Arlington, VA.

Introduction: Harm perceptions of menthol cigarettes may contribute to their appeal and use. African-Americans, women, and younger smokers disproportionately use menthol cigarettes, and may misperceive harm of menthol cigarettes.

Methods: Data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses of current adult smokers (18 and older) were used to estimate the correlates of menthol smoking among all cigarette brands and separately for the top three cigarette brands (Newport, Camel, and Marlboro). Adjusted models examined the main effect of menthol smoking on harm perceptions of one's own brand of cigarette and interactions with race/ethnicity, age, and gender.

Results: Menthol cigarettes were used by nearly 40% of current smokers, although the prevalence of menthol smoking differed across the top three brands (94% Newport, 46% Camel, and 18% Marlboro). Among menthol smokers, 80% perceived their cigarette as equally harmful, 14% perceived their brand as more harmful, and 7% perceived their brand as less harmful. In adjusted models, menthol smokers were more likely than nonmenthol smokers to misperceive their own brand as more harmful than other brands (compared to no difference in harm). Race and gender emerged as moderators of the association between menthol brand preference and harm perceptions.

Conclusions: In adjusted analyses, menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful than other brands, with differences by sub-groups who disproportionately use menthol.

Implications: Menthol cigarettes have been historically marketed with messages conveying lower harm than other cigarettes. Little is known about how contemporary adult menthol smokers perceive the harm of their usual brand, and potential differences by race, gender, and young adult versus older adult age group. After adjusting for other factors, menthol smokers were more likely than nonmenthol smokers to perceive their cigarette brand as more harmful than other brands. Further, the association between menthol smoking and harm perceptions differed by race and gender, but not by age group (young adult vs. older adult). This type of large-scale study identifies critical links between menthol smoking and harm perceptions among vulnerable smokers that will inform regulatory actions designed to decrease smoking-related harm.
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http://dx.doi.org/10.1093/ntr/ntx277DOI Listing
March 2019

Young adult non-smokers' exposure to real-world tobacco marketing: results of an ecological momentary assessment pilot study.

BMC Res Notes 2017 Aug 31;10(1):435. Epub 2017 Aug 31.

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

Background: The aims of this pilot study were to assess and characterize non-current smoking young adults' exposure to tobacco marketing through an ecological momentary assessment protocol.

Methods: Ecological momentary assessment (EMA) consists of repeated measurement of momentary phenomena and is well-suited to capture sporadic experiences in the real-world, such as exposure to tobacco marketing. EMA has the potential to capture detailed information about real-world marketing exposures in ways that reduce recall bias and increase ecological validity. In this study, young adults (n = 31; ages 18-25) responded to random prompts regarding their momentary exposure to tobacco marketing via text messages on their smartphones for 14 days (n = 1798 observations). Unadjusted and adjusted analyses were conducted using multilevel logistic regression to assess the odds of exposure accounting for correlation of multiple repeated measures within individuals while controlling for variability between individuals.

Results: Respondents reported, on average, two momentary exposures to tobacco advertising in the 14-day study period. In adjusted analyses, African-American (aOR 3.36; 95% CI 1.07, 10.54) and Hispanic respondents (aOR 5.08; 95% CI 1.28, 20.13) were more likely to report exposure to tobacco advertising. Respondents were also more likely to report exposure when also exposed to others using tobacco products and when they were at stores compared with at home (aOR 14.82; 95% CI 3.61, 60.88).

Conclusion: Non-smoking young adults report exposure to tobacco marketing particularly at the point-of-sale, with the highest likelihood of exposure among African-American and Hispanic young people. EMA protocols can be effective in assessing the potential impact of point-of-sale tobacco marketing on young adults.
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http://dx.doi.org/10.1186/s13104-017-2758-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580291PMC
August 2017

Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014).

Am J Prev Med 2017 Aug 16;53(2):139-151. Epub 2017 Mar 16.

Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York.

Introduction: The 2009 Family Smoking Prevention and Tobacco Control Act banned characterizing flavors other than menthol in cigarettes but did not restrict their use in other forms of tobacco (e.g., smokeless, cigars, hookah, e-cigarettes).

Methods: A cross-sectional analysis of Wave 1 data from 45,971 U.S. adults and youth, aged ≥12 years in the Population Assessment of Tobacco and Health (PATH) Study collected in 2013-2014, was conducted in 2016. This study examined (1) the prevalence and reasons for use of flavored tobacco products; (2) the proportion of ever tobacco users reporting that their first product was flavored; and (3) correlates of current flavored tobacco product use.

Results: Current flavored (including menthol) tobacco product use was highest in youth (80%, aged 12-17 years); and young adult tobacco users (73%, aged 18-24 years); and lowest in older adult tobacco users aged ≥65 years (29%). Flavor was a primary reason for using a given tobacco product, particularly among youth. Eighty-one percent of youth and 86% of young adult ever tobacco users reported that their first product was flavored versus 54% of adults aged ≥25 years. In multivariable models, reporting that one's first tobacco product was flavored was associated with a 13% higher prevalence of current tobacco use among youth ever tobacco users and a 32% higher prevalence of current tobacco use among adult ever users.

Conclusions: These results add to the evidence base that flavored tobacco products may attract young users and serve as starter products to regular tobacco use.
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http://dx.doi.org/10.1016/j.amepre.2017.01.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522636PMC
August 2017
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