Did You Know? Strong Local Tobacco Retail Licensing Ordinances Linked to Lower Tobacco Use among Youth

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Restricting youth access to tobacco is a central feature of US tobacco regulatory policy, but impact of local tobacco retail licensing (TRL) regulation on cigarette smoking rates remains uncertain. A newly published study examined the effects of TRL on other tobacco product use and use as adolescents reach the age to legally purchase tobacco products. Prevalences of ever and past 30-day cigarette, electronic cigarette (e-cigarette), cigar, and hookah use were assessed in a survey of a cohort of 1553 11th- and 12th-grade adolescents. An American Lung Association (2014) youth access grade was assigned to each of 14 political jurisdictions in which participants lived on the basis of the strength of the local TRL ordinance.

 

Findings included:

·         At baseline, participants living in 4 jurisdictions with “A” grades (ie, with most restrictive ordinances) had lower odds of ever cigarette use and past 30-day use than participants in 10 D- to F-grade jurisdictions.

·         At follow-up at legal age of purchase, lower odds of cigarette use initiation occurred in jurisdictions with stronger TRL policy.

·         Lower odds of e-cigarette initiation at follow-up and of initiation with past 30-day use were also associated with better regulation.

 

The researchers concluded that strong local TRL ordinance may lower rates of cigarette and e-cigarette use among youth and young adults.

 

Source: Astor et al. (2019). Tobacco Retail Licensing and Youth Product Use. Pediatrics, Jan 7. pii: e20173536. doi: 10.1542/peds.2017-3536. [Epub ahead of print]

 

Did You Know – That Modest Incentives Can Promote Equity in Utilization of Tobacco Cessation Services?

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Certain racial and ethnic minorities have lower utilization of tobacco cessation services, such as Helpline counseling and cessation medications. The goal of the California Medicaid (Medi-Cal) Incentives to Quit Smoking Program was to facilitate successful cessation by promoting modest financial and cessation medication-related incentives to increase engagement with the California Smokers’ Helpline counseling services. A newly published study examined differences in the response to incentives and outreach on engagement with Helpline services among racial/ethnic groups within the Medi-Cal population.
Findings included:
  •  African Americans and English-speaking Hispanics/Latinos had higher engagement with the financial incentive ($20) compared to whites.
  • Spanish-speaking Hispanics/Latinos had lower initial engagement with the financial incentive but higher engagement with Medi-Cal’s all-household mailing.
  • Although African Americans and English-speaking Hispanics/Latinos had similar rates of completing counseling and receiving nicotine replacement therapy as whites, Spanish-speaking Hispanics/Latinos had higher rates compared to whites.
The researchers concluded that the promotion of modest financial and cessation medication incentives through multiple outreach channels increased callers’ engagement with the Helpline and appeared to promote ethnic and linguistic equity with respect to the receipt of counseling and nicotine replacement therapy. Targeted community-based outreach may resonate particularly for African Americans, and language-concordant Medi-Cal insurance plan mailings may have reached newly covered Spanish-speaking Hispanics/Latinos.
Source: Vijayaraghavan et al. (2018). Racial/Ethnic Differences in the Response to Incentives for Quitline Engagement. American Journal of Preventive Medicine, Dec;55(6S2):S186-S195. doi: 10.1016/j.amepre.2018.07.018.

Urban and Rural Differences in Tobacco Retailer Exposure among Adolescents

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A newly published study whether self-reported and geographically estimated tobacco retailer exposures differ by participant or neighborhood characteristics among urban and rural adolescents. The data for this study were part of a cohort study of 1220 adolescent males residing in urban and rural (Appalachian) regions in Ohio. The baseline survey asked participants how often they visited stores that typically sell tobacco in the past week (self-reported exposures). The number of tobacco retailers between home and school was determined using ArcGIS software (potential exposures).

 

Findings included:

·         Adolescents who were non-Hispanic black or other racial/ethnic minority, had used tobacco in the past, and lived in rural areas had higher self-reported exposures.

·         Urban adolescents, non-Hispanic black or other racial/ethnic minority, and those living in neighborhoods with a higher percentage of poverty had more potential exposures to tobacco retailers in their path between home and school.

 

The researchers concluded that rural adolescents had more self-reported marketing exposures than urban adolescents. However, urban adolescents had more potential tobacco exposures between home and school. Thus, point of sale marketing limitations might be a more effective policy intervention in rural areas whereas limits on tobacco retailers might be more effective for urban areas.

 

Source: Burgoon et al. (2019). Exposures to the tobacco retail environment among adolescent boys in urban and rural environments. American Journal of Drug and Alcohol Abuse, Jan 2:1-10. doi: 10.1080/00952990.2018.1549562. [Epub ahead of print]

Study Examines why Bisexual Young Adults Use Tobacco at Higher Rates

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Little is known about why bisexual people use tobacco at higher rates than any other sexual identity group. Non-binary sexualities, such as bisexuality, exist within the socially constructed borderland between homosexuality and heterosexuality. A newly published study examined everyday smoking contexts and practices of bisexual individuals. Participants (n = 17; ages 18-26, California) identified as bisexual, pansexual, and/or queer.

 

Findings included:

·         Survey smoking patterns and situational predictors were similar to other young adults’.

·         However, interviews revealed unique roles of tobacco use in participants’ navigation of differently sexualized spaces in everyday life: 1) stepping away from uncomfortable situations related to bisexual identity; 2) facilitating belonging to LGBTQ+ community; and 3) recovering from bisexual identity perception management.

 

Source: McQuoid et al (2019). Tobacco use in the sexual borderlands: The smoking contexts and practices of bisexual young adults. Health & Place, Jan 10. pii: S1353-8292(18)30669-5. doi: 10.1016/j.healthplace.2018.12.010. [Epub ahead of print]

Youth Hookah Use Strongly Associated With Co-Use of Flavored Tobacco Products

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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).

 Findings included:

·         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]

Did You Know? Youth Believe that Ads for Flavored E-Liquids Target Them

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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.

 

Findings included:

  • 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]

Did You Know? California has Reduced Smoking Faster than the Rest of the US

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Three cigarette smoking behaviors influence lung cancer rates: how many people start, the amount they smoke, and the age they quit. California has reduced smoking faster than the rest of the US and trends in these 3 smoking behaviors should inform lung cancer trends. A newly published study examined trends in smoking behavior (initiation, intensity, and quitting) in California and the rest of US by regression models using the 1974-2014 National Health Interview Surveys (n=962,174).

 

Findings included:

·                     Among those aged 18- 35 years, California had much larger declines than the rest of the US in smoking initiation and intensity, and increased quitting.

·                     In 2012-14, among this age group, only 19% had ever smoked; smokers consumed only 6.3 cigarettes/day; and 46% of ever-smokers had quit by age 35.

·                     Each of these metrics was at least 24% better than in the rest of the US.

·                     There was no marked California effect on quitting or intensity among seniors. From 1986-2013, annual lung cancer mortality decreased more rapidly in California and by 2013 was 28% lower than in the rest of the US.

·                     California’s tobacco control efforts were associated with a major reduction in cigarette smoking among those under age 35 years.

 

The researchers concluded that these changes will further widen the lung cancer gap that already exists between California and the rest of the US.

 

Source: Pierce et al. (2018). Trends in lung cancer and cigarette smoking: California compared to the rest of the United States. Cancer Prevention Research, Oct 10. pii: canprevres.0341.2018. doi: 10.1158/1940-6207.CAPR-18-0341. [Epub ahead of print]

A Study Examines Perceived Positive And Negative Traits Of Adolescent E-Cigarette Users

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A newly published study examined the relationship between adolescents’ positive opinions of e-cigarette users and willingness to use e-cigarettes. Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015-2016.
Findings included:
  • 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.
Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents’ negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.
Source: McKelvey et al. (2018). Adolescents have unfavorable opinions of adolescents who use e-cigarettes. PloS One, Nov 7;13(11):e0206352. doi: 10.1371/journal.pone.0206352. eCollection 2018.
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Top Reason for E-Cigarette Use Among Young Adults: “They come in flavors I like”
A newly published study examined whether strong local policies may reduce e-cigarette initiation rates by influencing the appeal of these products. Online questionnaires were completed by Southern California Children’s Health Study participants in 2015-2016 (mean age?=?18.9?years).

Findings included:

  • 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 study authors recommend targeted policy that conveys the adverse impact of e-cigarettes, and restricts use in public places may reduce e-cigarette use among adolescents and young adults.
Source: Hong et al. (2018). The impact of local regulation on reasons for electronic cigarette use among Southern California young adults. Addictive Behaviors, Nov 16. pii: S0306-4603(18)31329-7. doi: 10.1016/j.addbeh.2018.11.020. [Epub ahead of print]

Combustible and Electronic Tobacco Use Frequently Featured in Popular Hip-Hop Music Videos

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A newly published study assessed the prevalence of the appearance and use of combustible and electronic tobacco and marijuana products, including brand placement, in leading hip-hop songs.

Analysis of top 50 songs from 2013 to 2017 of Billboard magazine’s weekly Hot R&B/Hip-Hop Songs with videos that included the appearance or use of combustible tobacco and marijuana products (manufactured cigarettes, cigars, hookah or waterpipe, pipe, hand-rolled tobacco and marijuana products, marijuana buds); appearance of exhaled smoke or vapor without an identifiable source product; appearance or use of electronic tobacco and marijuana products (eg, electronic cigarettes); tobacco or marijuana brand placement; appearance or use of combustible and electronic tobacco and marijuana by main or featured artist. Data were collected from December 6, 2017, to June 4, 2018.

 

Findings included:

·               The proportion of leading hip-hop videos containing combustible use, electronic use, or smoke or vapor ranged from 40.2% (76 of 189) in 2015, to 50.7% (102 of 201) in 2016.

·               For each year, the leading category of combustible use was hand-rolled products.

·               The appearance of branded products increased from 0% in 2013 (0 of 82) to 9.9% in 2017 (10 of 101) for combustible products, and from 25.0% in 2013 (3 of 12) to 87.5% in 2017 (14 of 16) for electronic products.

·               The prevalence of combustible or electronic product use or exhaled smoke or vapor increased by quartile of total number of views: 41.9% (8700 to 19 million views) among songs in the first quartile of viewership and 49.7% among songs in the fourth quartile of viewership (112 million to 4 billion views).

 

The researchers concluded that the genre’s broad appeal, use of branded products by influential artists, and rise of electronic product and marijuana use may contribute to a growing public health concern of tobacco and marijuana use.

 

Source: Knutzen et al. (2018). Combustible and Electronic Tobacco and Marijuana Products in Hip-Hop Music Videos, 2013-2017. JAMA Internal Medicine, Oct 15. doi: 10.1001/jamainternmed.2018.4488. [Epub ahead of print]

JUUL on eBay

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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.

Findings included:

  • 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