Did You Know: Less Than Half of Teachers and Parents Know What a JUUL Looks Like


Electronic cigarette use, including JUUL, has risen to epidemic levels among high school and middle school students in the United States. Schools serve as a key environment for prevention and intervention efforts to address e-cigarette use, yet little is known about the awareness of and response to e-cigarettes in schools. A newly published study of middle and high school teachers and administrators (n = 1,420) measured JUUL awareness, e-cigarette policies, and barriers to enforcement in schools.


Findings included:

  • While two thirds of respondents had heard of a product called JUUL (68%), less than half accurately identified a photo of a JUUL as a vaping device/e-cigarette (47%).
  • Awareness of JUUL (81%) was higher among high school teachers (83%) than among middle school teachers (78%).
  • A large majority of respondents reported that their school had an e-cigarette policy (83%), but less than half of the sample worked in a school with a policy that specifically included JUUL (43%).
  • Those working in a school with an e-cigarette policy in place noted that e-cigarettes’ discreet appearance (66%) and difficulties in identifying origin of vapor or scent (46%) made the policy difficult to enforce.


The researchers concluded that efforts to increase middle and high school staff awareness of the ever-evolving e-cigarette market are essential to help prevent youth use.


Source: Schillo et al. (2019). JUUL in School: Teacher and Administrator Awareness and Policies of E-Cigarettes and JUUL in U.S. Middle and High Schools. Health Promotion Practice, Sept 18. [Epub ahead of print]


Did You Know: Nicotine Dependence Is Linked To Cannabis Use Disorder Symptoms In Youth


A recently published study examined if cigarette smoking and/or nicotine dependence predicts cannabis use disorder symptoms among adolescent and young adult cannabis users and whether the relationships differ based on frequency of cannabis use. Data were drawn from seven annual surveys of the NSDUH to include adolescents and young adults (age 12-21) who reported using cannabis at least once in the past 30 days (n = 21,928).


Findings included:

  • Over half of current cannabis users also smoked cigarettes in the past 30 days (55%).
  • Cigarette smoking in the past 30 days was associated with earlier onset of cannabis use, more frequent cannabis use and a larger number of cannabis use disorder symptoms compared to those who did not smoke cigarettes.
  • Nicotine dependence but not cigarette smoking quantity or frequency was positively and significantly associated with each of the cannabis use disorder symptoms, as well as the total number of cannabis symptoms.

The researchers concluded that prevention and treatment efforts should consider cigarette smoking comorbidity when addressing the increasing proportion of the US population that uses cannabis.


Source: Dierker et al. (2018). Nicotine dependence predicts cannabis use disorder symptoms among adolescents and young adults. Drug and Alcohol Dependence, Apr 16;187:212-220. doi: 10.1016/j.drugalcdep.2018.02.037. [Epub ahead of print]

Did You Know: Among Sexual and Gender Minority Youth Smoking May Mean Having Control


A newly published study examined the meanings that sexual and gender minority youth ascribe to their tobacco use and how those meanings are shaped by the circumstances and structures of their everyday lives. This article is based on analysis of 58 in-depth qualitative interviews conducted with sexual and gender minority youth living in the San Francisco Bay area. The narratives illustrate how smoking signifies “control” in a multitude of ways, including taking control over an oppressor, controlling the effects of exposure to traumatic or day-to-day stress, and exerting control over the physical body in terms of protecting oneself from violence or defending one’s mental health. The authors conclude that these findings call into question the universal appropriateness of foundational elements that underlie tobacco control and prevention efforts directed at youth in the USA, specifically the focus on abstinence and future orientation.


Source: Antin et al. (2018). The “here and now” of youth: the meanings of smoking for sexual and gender minority youth. Harm Reduction Journal, May 31;15(1):30. doi: 10.1186/s12954-018-0236-8.

Did You Know? Flavors Like Menthol/Mint, Fruit and Candy Appeal to Young Tobacco Users


A recently published study examined youth preference for flavored tobacco products.

Findings included:

  • Prevalence of flavored tobacco product use was highest among youth, followed by young adults and adult 25+.
  • Within each age group, flavored use was greatest among hookah, e-cigarette and snus users.
  • Overall, menthol/mint, fruit and candy/sweet were the most prevalent flavor types at first and past 30-day use across age groups.
  • For past 30-day use, all flavor types except menthol/mint exhibited an inverse age gradient, with more prevalent use among youth and young adults, followed by adults 25+.
  • Prevalence of menthol/mint use was high (over 50% youth, young adults; 76% adults 25+).
  • Brand-categorized and self-reported flavor use measures among adults 18+ were moderately to substantially concordant across most products.


The researchers concluded that these findings can inform tobacco flavor regulations to address flavor appeal especially among youth.


Source: Rose et al. (2019). Flavour types used by youth and adult tobacco users in wave 2 of the Population Assessment of Tobacco and Health (PATH) Study 2014-2015. Tobacco Control, Sep 21. [Epub ahead of print]

LOOP Director Dr. Valerie Yerger Speaks to Cal Poly Students about Tobacco-Related Health Disparities

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On February 13, 2020, Dr. Yerger had the opportunity to “wake up” undergraduate students from various disciplines at the Cal Poly San Luis Obispo campus to tobacco-related health disparities. Her talk was part of Cal Poly’s “Inclusion Starts With Me” teach-in workshop.

As the California Tobacco Control Program is moving towards its EndGame, where the goal is to reach a statewide 0% smoking prevalence by the year 2035, Dr. Yerger is committed to there being no one “left behind.” An analogy she often references is that the EndGame is like a powerful, fast-moving locomotive, with a seat for everyone, that has already left the station. Dr. Yerger believes that to fill these seats, it is imperative to engage with priority populations, to reach out to non-traditional partners, and to inspire those who have not considered working in tobacco control to rethink their future career paths.


The LOOP Team is continually working toward the EndGame of 2035!

Young Adults’ Secondhand Smoke Exposure in San Francisco’s Multi-Unit Housing

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A newly published study evaluated young adults’ exposure to drifting secondhand smoke in San Francisco County housing units using the 2014 Bay Area Young Adult Health Survey (N = 1363). Specifically, the study examined whether residing in multiunit housing or in areas with greater neighborhood disorder were risk factors for exposure, and how drifting smoke exposure varied spatially within San Francisco County.


Findings included:

  • Residing in buildings with five or more units significantly increased the odds of reporting drifting smoke exposure.
  • Neighborhood disorder was significantly associated with exposure in lower income residential and downtown areas.
  • Multiunit housing was significantly associated with exposure across all neighborhoods.


Source: Holmes et al. (2019). Drifting Tobacco Smoke Exposure among Young Adults in Multiunit Housing. Journal of Community Health, Sep 18. [Epub ahead of print]


Did You Know? Youngest Teens (11-14) More Supportive of Tobacco 21


Tobacco 21 (T21) is a population-based strategy to prevent tobacco initiation. A majority of U.S. youths support T21; however, the extent to which individual, interpersonal, and community factors influence T21 support is uncertain. A newly published study examined predictors of T21 support among U.S. youth. Data from the 2015 National Youth Tobacco Survey were analyzed.


Findings included:

·         Among nonusers, students least receptive to peer influence, those youngest in age (11-14 years) and those who believe tobacco is dangerous had higher odds of T21 support.

·         Among users, lower odds of T21 support were observed among those who purchased tobacco and accessed tobacco through social sources or other means in the past 30 days.

·         Younger tobacco users (11-14 years), black, non-Hispanic users, e-cigarette users, and users who believe that tobacco is dangerous had higher odds of T21 support.


The researchers concluded that low receptivity to peer influence and lack of access to tobacco products are associated with T21 support.

Source: Glover-Kudon et al. (2019). Association of Peer Influence and Access to Tobacco Products With U.S. Youths’ Support of Tobacco 21 Laws, 2015. Journal of Adolescent Health, 65(2), 202-209.

Did You Know: In 2018, 64% of Youth Smokers Used Flavored Tobacco Products


The Food and Drug Administration (FDA) and CDC analyzed data from the 2014-2018 National Youth Tobacco Surveys (NYTS) to determine prevalence of current (past 30-day) use of flavored tobacco products, including electronic cigarettes (e-cigarettes), hookah tobacco, cigars, pipe tobacco, smokeless tobacco, bidis, and menthol cigarettes among U.S. middle school (grades 6-8) and high school (grades 9-12) students.


Findings included:

  • In 2018, an estimated 3.15 million (64.1%) youth tobacco product users currently used one or more flavored tobacco products, compared with 3.26 million (70.0%) in 2014.
  • Despite this overall decrease in use of flavored tobacco products, current use of flavored e-cigarettes increased among high school students during 2014-2018; among middle school students, current use of flavored e-cigarettes increased during 2015-2018, following a decrease during 2014-2015.
  • During 2014-2018, current use of flavored hookah tobacco decreased among middle and high school students; current use of flavored smokeless tobacco, cigars, pipe tobacco, and menthol cigarettes decreased among high school students.


The researchers concluded that full implementation of comprehensive tobacco prevention and control strategies, coupled with regulation of tobacco products by FDA, can help prevent and reduce use of tobacco products, including flavored tobacco products, among U.S. youths.


Source: Cullen et al. (2019). Flavored Tobacco Product Use Among Middle and High School Students – United States, 2014-2018. MMWR Morbidity and Mortality Weekly Report, Oct 4;68(39):839-844.

Study Examines Why Youth Engage with Online Tobacco Marketing


A newly published study examined the reasons why adolescents and young adults engage with online tobacco marketing. A sample of 2619 adolescents (13-17 years) and 2625 young adults (18-24 years) living in the US participated in an online survey in July-August 2017.


Findings included:

  • Across all tobacco use statuses, the leading reasons for engagement were curiosity or desire for general knowledge about tobacco products (3.9%); incidental, unintended or forced exposure to tobacco ad (3.8%); and seeking discounts, coupons, incentives, or contests (2.9%).
  • Susceptible never tobacco users were more likely to engage because of curiosity or general knowledge than non-susceptible never tobacco users.
  • Past 30-day tobacco users were more likely to engage because of discounts, coupons, incentives, or contests and product appeal than ever, but not past 30-day tobacco users.


The researchers concluded that stricter state and federal regulation of tobacco marketing, specifically tobacco ads and coupons, and stronger self-regulation by social networking sites could reduce youth engagement with online tobacco marketing.

Source: Soneji et al. (2019). Reasons for engagement with online tobacco marketing among US adolescents and young adults. Tobacco Induced Diseases, Jan 10;17:02.

Homeless Youth Tobacco Use Impacted by Tobacco Advertisement for Electronic Cigarettes and Hookah

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A recently published study examined associations between the appeal of advertising for 5 classes of tobacco product (electronic cigarettes, hookah, cigars, cigarillos, and smokeless tobacco) and future intentions to use those products again among homeless youth who had indicated lifetime use. A probability sample of 469 young tobacco users experiencing homelessness (mean age = 22; 71% male; 29% non-Hispanic White) was recruited from 25 service and street sites in Los Angeles County. The researchers found that advertising appeal was positively associated with future intentions to use again for electronic cigarettes and hookah, but not cigars, or cigarillos.

Results suggest that advertising appeal may increase use of certain tobacco products among youth experiencing homelessness. However, differences in themes emphasized by advertising for specific tobacco products could differentially influence use in this population.


Source: Shadel et al. (2019). Associations of Tobacco Advertising Appeal With Intentions to Use Alternative Tobacco Products Among Young Tobacco Users Experiencing Homelessness. American Journal of Health Promotion, Oct 3. [Epub ahead of print]