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


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


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

A New Study Examines Stealthy Vapor Devices Popular With Youth

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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. piitobaccocontrol-2018-054455. doi: 10.1136/tobaccocontrol-2018-054455. [Epub ahead of print]

Newly Published: Literature Review of Hookah Use among Youth

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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.

Findings included:

·         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].

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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]

Did You Know? Receptivity to Tobacco Advertising Is Associated With Progression Toward Use In Adolescents


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).

Findings included:

  • 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.

Findings included:

  • 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]

Did You Know? – Smoking is a Robust Marker for Risk of Negative Outcomes in Racial/Ethnic Minority Youth


A newly published study examined how smoking may differentially relate to the emergence of disparities in functioning across races/ethnicities over adolescence. Youth (n = 2,509) were surveyed eight times from ages 11 to 18. Researchers measured cigarette use, academic and social functioning, mental and physical health, and delinquency.

Findings included: 

  • Youth were 45% Hispanic, 20% , 20% white, 10% multiethnic, 2% black, and 1% other ethnicities.
  • Higher average probability of smoking and steeper slopes of smoking trajectories were associated with poorer outcomes in multiple domains:

·        Black, Hispanic, and multiethnic youth reported lower academic performance.

·        Asian, black, and multiethnic youth reported higher academic unpreparedness.

·        Asian and multiethnic youth reported poorer mental health.

·        Asian, Hispanic, and multiethnic youth reported poorer physical health.

·        Asian youth reported higher delinquency and poorer social functioning.

The researchers concluded that racial/ethnic minority youth demonstrated poorer outcomes in multiple domains compared with white peers. Smoking may be a particularly robust marker for risk of negative outcomes in racial/ethnic minority youth.

Source: Dunbar et al. (2018). Ethnic Differences in Cigarette Use Trajectories and Health, Psychosocial, and Academic Outcomes. Journal of Adolescent Health, Mar, 62(3):327-333.

Read the abstract at https://www.tcspartners.org/login.cfm 

Did You Know? – Youth Peer Crowd Identification Is Linked To Tobacco Use

cigaretteResearch has demonstrated that Hip Hop peer crowd identification, which is common among multicultural youth, is associated with increased risk of tobacco use. To address this, the FDA Center for Tobacco Products created Fresh Empire, the first national tobacco education campaign tailored for Hip Hop youth aged 12-17 who are multicultural (Hispanic, African American, Asian-Pacific Islander, or Multiracial). A recently published studyexamined peer crowd (Hip Hop, Mainstream, Popular, Alternative, Country) and cigarette smoking status among a nationally recruited sample of youth, aged 13-17. The study found that Alternative youth were most at risk of cigarette smoking, followed by Hip Hop. Specifically, Hip Hop youth were significantly more likely to be experimenters than Popular and Mainstream youth.

The researchers concluded that the current study underscores the potential utility of interventions tailored to larger at-risk crowds for campaigns like Fresh Empire.




There are organizations and individuals who are stepping up to change this statistic. On March 15th, 2018, Godfrey Ramos from The LOOP was invited to give a presentation at the 19th Annual Leaders in Life youth conference in Bakersfield. His workshop focused on how to use Hip Hop Culture as a tool to promote student led tobacco-free projects and dialogue. As a culture, Hip Hop consists of five core elements: Emceeing/Rappin, DJing, Graffiti Art, Breakdancing, and Knowledge. The workshop utilized these five elements to highlight strategies on how to get the word out to peers, and the community, about advocacy efforts that make sure youth voices are heard and a powerful story is told that shapes and influences decision-making. The workshop was attended by approximately 200 students, parents, educators, and community leaders.

To learn more about the Leaders in Life Youth conference, please visit: http://leadersinlife.org/


Walker et al. (2018). The Hip Hop peer crowd: An opportunity for intervention to reduce tobacco use among at-risk youth. Addictive Behaviors, Feb 10;82:28-34. doi: 10.1016/j.addbeh.2018.02.014. [Epub ahead of print]

Read the abstract at: https://www.ncbi.nlm.nih.gov/pubmed/29477904

That Homelessness And HIV Status Are Associated With Smoking Among Sexual And Gender Minorities Youth?
A recently published study examined rates and correlates of tobacco use among young men who have sex with men (YMSM) and transgender women. A total of 771 participants were drawn from thebaseline assessment of an ongoing longitudinal cohort study of racially diverse MSM aged 16-29 years. Data collection took place in 2015-2016.

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