Did You Know? Youth Exposure to E-Cigarette Advertising is Highest in Retail Stores

smoking kids

A newly published Morbidity and Mortality Report (CDC, March 2018) focused on the exposure to electronic cigarette advertising among middle and high school students. To assess patterns of self-reported exposure to four e-cigarette advertising sources (retail stores, the Internet, television, and newspapers and magazines), CDC researchers analyzed data from the 2014, 2015, and 2016 National Youth Tobacco Surveys (NYTSs).

Findings included:

  • Overall, exposure to e-cigarette advertising from at least one source increased each year during 2014-2016 (2014: 68.9%; 2015: 73.0%; 2016: 78.2%).
  • In 2016, exposure was highest for retail stores (68.0%), followed by the Internet (40.6%), television (37.7%), and newspapers and magazines (23.9%).
  • During 2014-2016, youth exposure to e-cigarette advertising increased for retail stores (54.8% to 68.0%), decreased for newspapers and magazines (30.4% to 23.9%), and did not significantly change for the Internet or television.


Recommendations include reducing youth exposure to e-cigarette advertising from a range of sources, including retail stores, television, the Internet, and print media such as newspapers and magazines.

Source: Marynak et al. (2018). Exposure to Electronic Cigarette Advertising Among Middle and High School Students – United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018 Mar16, 67(10), 294-299.

Did You Know? Smoking Cessation Could Improve HIV Outcomes For Sexual Minority Men With HIV

Cigarette smoking is particularly harmful for sexual minority men living with HIV. A newly published study examined the benefits of quitting by examining relationships between smoking and sustained HIV RNA suppression, recent CD4 count, ART medication adherence, and engagement in HIV medical care. Sexual minority men (n = 346), former or current smokers, received HIV care at a community health center. Most patients were Caucasian (87%), 148 (46%) had incomes below the poverty level and 80% had sustained HIV RNA suppression. Compared to current smokers, former smokers had increased odds of sustaining HIV RNA suppression, of reporting > 90% treatment adherence, and were less likely to miss appointments. Heavier smokers and patients who smoked the longest had reduced odds of sustaining HIV RNA suppression. The researchers concluded that smoking assessment, treatment, and referral could augment HIV outcomes for sexual minority men with HIV.
Source: King et al. (2018). Treatment Outcomes Associated with Quitting Cigarettes Among Sexual Minority Men Living with HIV: Antiretroviral Adherence, Engagement in Care, and Sustained HIV RNA Suppression. AIDS and Behavior, Apr 21. doi: 10.1007/s10461-018-2116-3. [Epub ahead of print]



That Tobacco Cessation Programs May Want To Target Low SES Sexual Minorities Within A Context Of Co-Occurring Substance And Alcohol Use?

Cigarette smoking is substantially more prevalent and rates of smoking cessation are lower in low-SES adults. Financial strain may be one explanation for this. A newly published study assessed the link between financial strain, quit attempts, and successful smoking cessation among adult smokers in the U.S. Data from the Population Assessment of Tobacco and Health Study (2013-2015) were analyzed.

Findings included:

  • Smokers with financial strain made more quit attempts than smokers without financial strain, but financial strain was not associated with abstinence at follow-up.
  • Low income was associated with less abstinence at follow-up.
  • Smokers with baseline financial strain who quit at follow-up had lower odds of financial strain at follow-up.

The researchers concluded that financially strained smokers made slightly more quit attempts than non-strained smokers but were no more likely to successfully quit.

Source: Kalkhoran et al. (2018). Financial Strain, Quit Attempts, and Smoking Abstinence Among U.S. Adult Smokers. American Journal of Preventive Medicine, Apr 5. pii: S0749-3797(18)30068-0. doi: 10.1016/j.amepre.2018.01.036. [Epub ahead of print]

Read the abstract at: https://www.ncbi.nlm.nih.gov/pubmed/29628382

Did You Know? Hookah Smoking is Common Among College Students

hookah 2
A recently published study reported on the first nicotine product used among undergraduates who had ever tried tobacco, and explores correlates of hookah as that first product. Participants included a convenience sample of undergraduate students (n = 1538) at four universities in upstate New York during fall 2013. 
Findings included: 
  • Among the 832 students who reported ever use of any nicotine product, 25.4% reported hookah as their first product smoked; only combustible cigarettes (39.5%) were reported more frequently. 
  • Among students who ever smoked cigarettes, most reported cigarettes as their introductory product. 
  • Among students who never smoked cigarettes, nearly half reported hookah as their introductory product. 
  • Among ever nicotine users, current hookah smoking was common (34.9%), and greater than current e-cigarette (25.9%) and current combustible cigarette (26.4%) use. 
  • Never users of cigarettes, females, and non-Hispanic African Americans, had higher adjusted odds of reporting hookah as their introductory product.
The researchers’ recommendations include broadening prevention efforts beyond a focus on combustible cigarettes.
Source: Kulak et al. (2018). Examining Hookah as an Introduction to Nicotine Products among College Students. Substance Use & Misuse, Mar 13:1-9. doi: 10.1080/10826084.2018.1441308. [Epub ahead of print]

Lack of Public Health Messages About Hookah Use Maybe Interpreted As Sign That Hookah Use is Safe

The rate of Hookah use among college students during the last decade is about 30%. Presently, the US Food and Drug Administration (FDA) has little regulation for the manufacture, distribution, or sale of hookah. A recently published review of the scientific literature assessed hookah use while focusing on the consequences for regulatory policy.
Findings included:
  • Hookah use may initiate smoking among tobacconaïve college students.
  • College students who use hookah are generally not aware of the increased risks for tobacco related diseases as it relates to their behavior.
  • Few public health messages target college-age adults with anti-hookah messages.
  • A lack of information regarding the dangers and potential harms of hookah use may be misinterpreted as a sign of “safety” which inadvertently may imply a suggestion of no need for safety measures.
Source: Fevrier et al. (2018). Policy Implications and Research Recommendations: A Review of Hookah Use Among US College Students. Journal of Community Health, Mar 30. doi: 10.1007/s10900-018-0502-4. [Epub ahead of print]

Study Finds Weaker Protective Effect of Higher Education On Smoking For Blacks Than Whites


A newly published study examined whether higher socioeconomic status (SES) has the same protective effects on smoking for Blacks and Whites. This cross-sectional study used the Health Information National Trends Survey (HINTS), a national survey of American adults.

Findings included:

  • Higher educational attainment was associated with lower odds of ever and current smoking.
  • There was a stronger protective effect of higher education against current smoking for Whites than Blacks.
  • Race did not interact with the effect of educational attainment on odds of ever smoking .

In line with previous research in the United States, education is more strongly associated with health and health behaviors in Whites than Blacks.

Source: Assari & Mistry (2018). Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks’ Diminished Return. International Journal of Environmental Research and Public Health, Apr 16;15(4). pii: E763. doi: 10.3390/ijerph15040763.


Did You Know? Black-Latinos Are More Likely To Smoke Menthol Cigarettes Compared to White-Latinos

Using data from the National Adult Tobacco Survey (NATS), a newly published study examined the relationship between race and smoking behaviors among Latinos/Hispanics. The study sample included 505 Black-Latinos and 9078 White-Latinos. While no racial differences were found in lifetime smoking status among Latinos, Black-Latinos had a 17% increased risk of menthol smoking compared to White-Latinos. The researchers concluded that menthol consumption is influenced by race among Hispanics/Latinos. In order to address racial disparities among Latinos/Hispanics, further attention needs to be given to racial differences in smoking-related risks among Latinos/Hispanics.
Source: Cuevas et al. (2018). Assessing racial differences in lifetime and current smoking status & menthol consumption among Latinos in a nationally representative sample. Ethnicity & HealthMar 14:1-17. doi: 10.1080/13557858.2018.1447651. [Epub ahead of print]
Read Abstract here 

The LGBT Community & E-Cigarettes


A study originally published in 2015 comprehensively examined patterns and correlations of current e-cigarette use among U.S. adults, identifying important variations among priority populations.

LGBT respondents had higher rates of both cigarette smoking (32.4% vs 20.3%) and of e-cigarette use than heterosexual respondents (25.1% vs 14.3%for ever use and 9.4% vs 4.9% for current e-cigarette use). Although there are no significant differences in e-cigarette awareness across income levels, a clear inverse relationship existed between income and rates of both e-cigarette use and smoking. Those with lower education levels tended to have higher rates of e-cigarette use and smoking than those with collegeeducation.

The analyses revealed that the LGBT subpopulation had higher rates of both ever and current e-cigarette use. However, after controlling for smoking status and quitting behaviors, the coefficient for LGBT respondents became statistically insignificant. Because current cigarette smokers are more likely to use e-cigarettes, higher rates of e-cigarette ever use and use among LGBT individuals were primarily driven by high cigarette smoking rates among sexual minorities. Nonetheless, future efforts to address the high rates of tobacco use among sexual minorities, including both combustible and electronic cigarettes, are warranted.

Read the abstract here.

LGBT Pride Month

In honor of LGBT Pride Month, we wanted to spotlight this community with some tobacco-related information: some key facts, a newly revised booklet published by TECC, and an article on e-cigarettes and the LGBT community.

The Tobacco Education Clearinghouse of California (TECC) has published a newly revised booklet called How the Tobacco Industry Exploits the LGBT Community. This 8-page booklet examines the tobacco industry’s marketing tactics that target the LGBT community. It discusses advertising ploys, tobacco sponsorship of LGBT events, and offers suggestions on how community members can fight this exploitation.
You can download this booklet here.

Take Advantage of The LOOP’s FREE Tailored Assistance Services!

A primary service offering of The LOOP is to provide tailored assistance to CTCP grantees’ requests, enabling them to implement more effectively their local tobacco control interventions and initiatives. This is a FREE service provided to statewide CTCP grantees.
We have identified and recruited subject matter experts with diverse backgrounds from around the state to provide trainings and tailored assistance that cover a range of tobacco control topics, as well as other areas pertinent to reaching and serving California’s diverse priority populations.




Two of our LOOP experts, Dr. Valerie Yerger and Carol McGruder, were instrumental to the local education and advocacy efforts that led to the passage of Prop E in San Francisco!

Click here for the full list of services.

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What are your organization’s needs? Book your Tailored Assistance Trainer today by emailing us at TheLOOP@ucsf.edu

Making Headlines: San Francisco Passes Ban on Flavored Tobacco


A proposal to ban the sale of candy-flavored tobacco products in San Francisco was supported by the majority of the city’s voters in Tuesday’s election.

According to preliminary results from the city’s Department of Elections, Proposition E was approved by 68 percent of the vote.

The proposition would uphold the San Francisco Board of Supervisors’ unanimous vote to ban the products and other flavored tobacco, including menthol cigarettes.

Did You Know? Among California Youth, Prevalence of E-Cigarette Use is Highest Among Non-Hispanic White Boys and Asian Girls


A newly published study sought to determine e-cigarette use prevalence and its relation to alcohol use as a potential gateway drug, and how this may differ by sex and ethnicity in a multi-ethnic sample of California adolescents. The researchers analyzed data from 1806 adolescents aged 12-17 in the 2014 and 2015 California Health Interview Survey (CHIS) cycles.

Findings included:

  • The prevalence of e-cigarette use was 9.1% overall in California adolescents but highest in boys among non-Hispanic Whites (15.1%) and in Asian girls (13.3%).
  • Among e-cigarette users, 61.3% of boys and 71.0% of girls reported using alcohol as well.

The researchers concluded that attention needs to be paid to the high prevalence of e-cigarette smoking, as well as its potential as a gateway drug for alcohol drinking in adolescents.

Source: Wong & Fan, (2018). Ethnic and sex differences in E-cigarette use and relation to alcohol use in California adolescents: the California Health Interview Survey. Public Health, Mar 7;157:147-152. doi: 10.1016/j.puhe.2018.01.019. [Epub ahead of print]

Get the abstract on Infohub

Literature Review Of Characteristics Of Adolescent E-Cigarette Users
A newly published article reviewed the existing e-cigarette literature for the characteristics of adolescents most likely to become e-cigarette users. A total of 100 articles were found, and 25 were finally included in the present review. The researchers found that older age, male gender, conventional smokers, peer influence, daily smoking, and heavier smoking are the most common characteristics of adolescent e-cigarette users. Since e-cigarette use is increasing and considering that the long-term health effects are still under investigation, targeted interventions towards more susceptible individuals may be an effective prevention strategy.
Source: Perikleous et al. (2018). E-Cigarette Use Among Adolescents: An Overview of the Literature and Future Perspectives. Frontiers in Public Health, Mar 26;6:86. doi: 10.3389/fpubh.2018.00086.
Get the paper on Infohub