- E-cigarette use increased in the years following the ban while combustible cigarette use decreased from 2013 to 2016.
- Men were more likely than women to use both products.
- Students’ perceptions of the harmfulness of combustible and electronic cigarettes remained stable in the years following the ban.
A recently published study examined three social dimensions of youth hookah smoking: frequency, places smoked, and descriptive social norms. Researchers analyzed data from the 2016 National Youth Tobacco Survey of US sixth- to 12th-graders (n = 20,675).
· Overall, 10.5% reported smoking hookah ≥1 time in their lifetime. Of these, 65.8% were former, 26.3% were current occasional, and 7.9% were current frequent smokers.
· Overall, 59.3% of students overestimated hookah smoking prevalence in their grade.
· Current frequent smoking was most strongly predicted by living with a hookah smoker, speaking a second language other than English, and co-use of mentholated cigarettes or other flavored non-cigarette tobacco products.
· The top 3 places hookah was smoked were a friend’s house (47.7%), the respondent’s own house (31.8%), and another family member’s house (20.8%).
The researchers concluded that because the home environment was the most common place for youth hookah smoking, home-tailored interventions that encourage voluntary smoke-free rules and warn about the dangers of social smoking could help denormalize hookah smoking.
Source: Agaku et al. (2018). Social aspects of hookah smoking among US youth. Pediatrics, July 2, [Epub ahead of print]
The e-cigarette industry argues that flavors are not meant to appeal to youth, yet no study has asked youth what age group they think ads for flavored e-liquids are targeting. A newly published study asked youth which age group they thought ads for flavored e-liquids targeted. A random sample of 255 youth from across California viewed eight ads, presented in randomized order, for fruit-, dessert-, alcohol-, and coffee-flavored e-liquids and indicated the age group they thought the ads targeted: younger, same age, a little older, or much older than them.
- Most participants (94%) indicated the cupcake man flavor ad targeted an audience of people younger than they.
- Over half felt ads for smoothy (68%), cherry (64%), vanilla cupcake (58%), and caramel cappuccino (50%) targeted their age and for no flavor ad did most feel the primary target age group was much older.
- Youth believe ads for flavored e-liquids target individuals about their age, not older adults.
The researchers concluded that findings support the need to regulate flavored e-liquids and associated ads to reduce youth appeal, which ultimately could reduce youth use of e-cigarettes.
Source: McKelvey et al. (2018). Youth say ads for flavored e-liquids are for them. Addictive Behaviors, Aug 29. pii: S0306-4603(18)30957-2. doi: 10.1016/j.addbeh.2018.08.029. [Epub ahead of print]
- The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users.
- Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users.
- Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users.
- Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users.
- Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users.
- The top reason for e-cigarette use was “They come in flavors I like” (57%).
- Using e-cigarettes to quit smoking was uncommon (13%).
- Participants in jurisdictions with weaker tobacco retail licensing ordinances were more likely to report use of e-cigarettes because they are less harmful than cigarettes (50% vs. 36%), more acceptable to non-tobacco users (38% vs. 25%), and because they can use e-cigarettes in places where smoking is prohibited (31% vs. 18%).
The novel e-cigarette product JUUL has experienced rapid market growth. The online auction site eBay has been mentioned as a source of JUUL access for youth, and the US Food and Drug Administration (FDA) notified eBay to remove JUUL listings in April 2018. A newly published study sought to characterize the sale of JUUL products on eBay prior to the FDA’s request, document the impact of this request and explore ways in which eBay vendors bypassed this effort. The researchers searched eBay for JUUL-branded products sold by US vendors in March 2018, yielding a sample of 197 listings for devices and/or pods. Each listing was coded for product, listing and youth access content. Following FDA action, each listing was revisited to determine its status, and each vendor’s page was searched for JUUL and other vaping content.
- Of 197 eBay listings, 189 were for JUUL kits and 13 were for pods.
- Prices were on average higher than those on the official JUUL store, and language about age restrictions was rare.
- Following FDA contact, most listings were no longer active. However, 3.4% of these vendors still sold JUUL devices or pods and 15.5% were selling other vaporizers or nicotine products.
The researchers concluded that online platforms may lack the will or expertise to effectively monitor content for tobacco products, while vendors quickly adapt to minor changes with simple strategies such as spelling variations. Accurate identification of online e-cigarette vendors is essential to the enforcement of policy and may benefit from cross-sector partnerships.
Source: Laestadius & Wang (2018). Youth access to JUUL online: eBay sales of JUUL prior to and following FDA action. Tobacco Control, Sep 5. pii: tobaccocontrol-2018-054499. doi: 10.1136/tobaccocontrol-2018-054499. [Epub ahead of print]
Read the abstract at: https://www.ncbi.nlm.nih.gov/pubmed/30185531
A newly published article examined stealthy vapor devices, as well as low-odor and low-vapor e-juices, via a comprehensive online search between March and June 2018. As evidence of their popularity, a search for ‘stealth vaping’ on YouTube found 18,200 videos. A variety of cleverly designed vapor devices disguised as USB sticks, pens, remote controls, car fobs, smart phones, sweatshirt drawstrings and even asthma inhalers are on the market. JUUL, which resembles a USB stick, is the archetype of these devices and is especially popular among youth. A search of ‘JUUL’ on YouTube yielded 148 000 videos with 57 videos having >100 000 views. Searches on ‘JUUL at school’ (15 500), ‘JUUL in class’ (6840), ‘hiding JUUL in school’ (2030) and ‘JUUL in school bathroom’ (1040) illustrate the product’s popularity among students. Some e-juices promote themselves as having low visibility plumes while others profess to be of subtle odor to avoid detection. Numerous techniques have been described to hide the exhaled vapor plume such as by swallowing it or blowing it into one’s clothing or into a backpack.
The researchers concluded that the vaping industry has demonstrated much ingenuity in devising discreet vaporizers and de-emphasizing exhaled vapor plumes and their aroma. The US market for vaping devices with stealthy characteristics is anything but inconspicuous, with JUUL alone accounting for 70.5% of sales (July 2018).
Source: Ramamurthi et al. (2018). JUUL and other stealth vaporizers: hiding the habit from parents and teachers. Tobacco Control, Sep 15. pii: tobaccocontrol-2018-054455. doi: 10.1136/tobaccocontrol-2018-054455. [Epub ahead of print]
- College educated persons (vs. those with less than a high school diploma) had a 37% greater prevalence of current ENDS use and a 16% greater prevalence of former ENDS use.
- Persons with household incomes above $90K (vs. less than $20,000) had a greater prevalence of current and former ENDS use.
- Those who were employed (vs. not employed) had a 13% greater prevalence of current ENDS use.
- Higher SES (vs. lower SES) persons were more likely to use ENDS.
This systematic review summarizes and assesses the literature related to hookah use among adolescents (11 to 18 years of age) in the U.S. from 2009 to 2017. Authors reviewed 461 articles for inclusion and included 55 articles which were coded for study themes, study quality and their relevance to FDA’s research priorities.
· The following themes were identified: (1) prevalence of hookah use (n=42); (2) tobacco use transitions (n=7); (3) sociodemographic correlates (n=35); (4) psychosocial risk factors (n=21); (5) concurrent use of other tobacco products (n=31); (6) concurrent use of other substances (n=9); and (7) other (n=15) which includes low prevalence themes.
· Older age, male gender, positive social normative beliefs, higher peer use as well as lower perceived risk were associated with hookah use.
· Longitudinal studies of youth hookah use showed bidirectional relationships between use of hookah and other tobacco products.
· All articles fell within FDA’s research priority related to “behavior.” Three priorities (“impact analysis,” “health effects,” and “toxicity”) have not been explored for hookah use among U.S. youth since 2009.
The researchers concluded that the prevalence of hookah use among youth in the U.S. is increasing, thus more research is needed to inform policies targeted to protect this vulnerable population.
Source: Cooper et al. (2018). Hookah Use among U.S. Youth: A Systematic Review of the Literature from 2009-2017. Nicotine & Tobacco Research, Jun 28. doi: 10.1093/ntr/nty135. [Epub ahead of print].
Who Is More Likely To Initiate Tobacco Product Use: Youth or Young Adults?
A recently published study examined the initiation of tobacco product use, including cigarettes, e-cigarettes, cigar products, and hookah, among contemporary youth and young adults, to determine whether the developmental timing (youth vs. young adulthood) of initiation has changed. Researchers analyzed data from the national Population Assessment of Tobacco and Health Study, and two Texas cohort studies, the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), and the Marketing and Promotions Across Colleges in Texas (M-PACT) project. Findings indicate that young adults who were never users began to ever and currently use all tobacco products more than youth in these samples, a marked departure from prior decades of research.
Source: Perry et al. (2018). Youth or Young Adults: Which Group Is at Highest Risk for Tobacco Use Onset? The Journal of Adolescent Health, Jul 7. pii: S1054-139X(18)30188-5. doi: 10.1016/j.jadohealth.2018.04.011. [Epub ahead of print]
A newly published study investigated whether receptivity to tobacco advertising among youth and young adults is associated with progression (being a susceptible never user or ever user) to use of the product advertised, as well as conventional cigarette smoking. For that purpose, researchers analyzed data from the Population Assessment of Tobacco and Health (PATH) Study at wave 1 (2013-2014) and 1-year follow-up at wave 2 (2014-2015) which was conducted in a US population-based sample of never tobacco users aged 12 to 24 years from wave 1 of the PATH Study (N = 10,989).
- Receptivity to any tobacco advertising at wave 1 was high for those aged 12 to 14 years but highest for those aged 18 to 21 years.
- E-Cigarette advertising had the highest receptivity among all age groups.
- For those aged 12 to 17 years, susceptibility to use a product at wave 1 was significantly associated with product use at wave 2 for conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco products.
- Among committed never users aged 12 to 17 years at wave 1, any receptivity was associated with progression toward use of the product at wave 2.
The researchers concluded that receptivity to tobacco advertising was significantly associated with progression toward use in adolescents. Receptivity was highest for e-cigarette advertising and was associated with trying a cigarette.
Source: Pierce et al. (2018). Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study. JAMA Pediatrics, Mar 26. doi: 10.1001/jamapediatrics.2017.5756. [Epub ahead of print]
Did You Know? A Quarter Of Youth Who Have Never Used Tobacco Products Are Open To Using E-Cigarettes
A newly published study examined how e-cigarette harm perceptions and advertising exposure are associated with openness and curiosity among tobacco naive youth. Findings from the 2015 National Youth Tobacco Survey were analyzed.
- Among respondents who never used tobacco products, 24% were open to using e-cigarettes and 25% were curious.
- Respondents that perceived e-cigarettes to cause a lot of harm had lower odds of both openness and curiosity about e-cigarettes compared to those with lower harm perception.
- Respondents who reported high exposure to e-cigarette advertising in stores had greater odds of being open to e-cigarette use and highly curious compared to those not highly exposed.
The researchers concluded that youth exposed to e-cigarette advertising are open and curious to e-cigarette use. These findings could help public health practitioners better understand the interplay of advertising exposure and harm perceptions with curiosity and openness to e-cigarette use in a rapidly changing marketplace.
Source: Margolis et al. (2018). E-cigarette openness, curiosity, harm perceptions and advertising exposure among U.S. middle and high school students. Preventive Medicine, Apr 17, 112:119-125. doi: 10.1016/j.ypmed.2018.04.017. [Epub ahead of print]
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).
- 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.