Prevalence and correlates of prior experimentation with e-cigarettes over conventional cigarettes among adolescents: Findings from the 2015 Korea Youth Risk Behaviour Web-based Survey.
ABSTRACT: INTRODUCTION:As concern is increasing about electronic cigarette use among never-smoking youth, we aimed to examine the prevalence and correlates of prior experimentation of electronic cigarettes (e-cigs) over conventional cigarettes (c-cigs). METHODS:We used the 10th Korea Youth Risk Behavior Web-based Survey in 2015, including 67960 participants as study subjects. This survey was designed as stratified multistage clustered samples from middle schools and high schools. Weighted percentages of vaping and/or smoking status by the timing of experimentation were calculated and multivariate logistic regression analysis was conducted after adjustments for possible confounders (demographics, socioeconomic status, lifestyle, tobacco use pattern). RESULTS:Youth who use e-cigs only or before c-cigs were 1.7% and 9.1% of any type user, respectively. In younger participants, the proportion tended to be increasing. Apart from being younger (AOR=2.23, 95% CI: 1.66-2.99; 12th grade vs 7th grade), male gender (AOR=1.20, 95% CI: 1.03-1.42), higher household income (AOR=1.21, 95% CI: 1.01-1.45), higher school performance (AOR=1.19, 95% CI: 1.02-1.39), exposure to smoke (AOR=1.63, 95% CI: 1.43-1.86) and caffeine drink (AOR=1.44, 95% CI: 1.24-1.68) were associated with experimentation with e-cigs prior to c-cigs in a fully-adjusted model. Alcohol abuse (AOR=0.57, 95% CI: 0.48-0.68) and weekday internet usage for recreation (AOR=0.69, 95% CI: 0.60-0.78) were negatively associated. CONCLUSIONS:The characteristics of those who experiment with e-cigs over c-cigs may be different from the general characteristics of vaping. Considering recent e-cig epidemics, more attention should be paid to the adolescents who tend to start e-cigs first.
Project description:There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren's (aged 7-11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children's perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation.
Project description:Importance:Several states have banned sales of flavored e-cigarettes, but evidence on the association between vaping flavors and subsequent smoking initiation and cessation is limited. Objective:To evaluate whether new uptake of flavored e-cigarettes is more strongly associated with subsequent smoking initiation and cessation than uptake of unflavored e-cigarettes, separately for youths (12-17 years), emerging adults (18-24 years), and prime-age adults (25-54 years). Design, Setting, and Participants:This cohort study conducted secondary data analyses of longitudinal survey data from waves 1 to 4 of the Population Assessment of Tobacco and Health Study (collected from 2013 to 2018). The analytic sample was limited to 17?929 respondents aged 12 to 54 years at wave 1 who completed at least 3 consecutive waves of the survey and did not use e-cigarettes at baseline. Data were collected from 2013 to 2018 and analyzed in February 2020. Exposures:Flavored vs unflavored e-cigarette use reported in wave 2 of the Population Assessment of Tobacco and Health Study. Main Outcomes and Measures:Binary indicators captured wave 3 smoking among 7311 youths and 4634 emerging adults who did not smoke at baseline (ie, initiation) and not smoking at wave 3 among 1503 emerging adults and 4481 prime-age adults who smoked at baseline (ie, cessation). Smoking status was based on having smoked in the past 30 days for youths and established smoking (ie, current smoking among those who smoked at least 100 cigarettes in their lifetime) for emerging and prime-age adults. Results:The youths who did not smoke at baseline, emerging adults who smoked at baseline, and prime-age adults who smoked at baseline consisted of 51.4% to 58.0% male participants and 66.9% to 77.0% white individuals. Vaping uptake was positively associated with smoking initiation in youth (adjusted odds ratio [AOR], 6.75; 95% CI, 3.93-11.57; P?<?.001) and in emerging adults (AOR, 3.20; 95% CI, 1.70-6.02; P?<?.001). Vaping uptake was associated with cessation in adults (AOR, 1.34; 95% CI, 1.02-1.75; P?=?.03). Vaping nontobacco flavors was no more associated with youth smoking initiation than vaping tobacco-flavors (AOR in youth, 0.66; 95% CI, 0.16-2.76; P?=?.56) but was associated with increased adult smoking cessation (AOR in adults, 2.28; 95% CI, 1.04-5.01; P?=?.04). Conclusions and Relevance:In this study, adults who began vaping nontobacco-flavored e-cigarettes were more likely to quit smoking than those who vaped tobacco flavors. More research is needed to establish the relationship between e-cigarette flavors and smoking and to guide related policy.
Project description:OBJECTIVE:Previous research suggests that some adolescents are using e-cigarette devices to vaporise ('vaping') cannabis in the form of hash oil, tetrahydrocannabinol (THC) wax or oil, or dried cannabis buds or leaves. However, it is unclear how adolescents who vape cannabis use other tobacco products. This study examined the extent to which adolescents reported ever vaping cannabis and investigated how demographic variables and tobacco behaviours were associated with use. DESIGN:We used cross-sectional data from adolescents (total response rate 64.5%) who participated in the 2017 North Carolina Youth Tobacco Survey. SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. SETTING:North Carolina, USA. PARTICIPANTS:Adolescents in high school (n=2835). PRIMARY OUTCOME AND MEASURE:Adolescents were asked to indicate whether they had ever used an e-cigarette device with marijuana, THC or hash oil, or THC wax. RESULTS:Approximately 1 in 10 high school students reported ever vaping cannabis in the overall sample (9.6%). In multivariable models, adolescents who reported using cigars (adjusted OR (aOR) 3.76, 95% CI 2.33 to 6.07), waterpipe (aOR 2.32, 95% CI 1.37 to 3.93) or e-cigarettes (aOR 3.18, 95% CI 2.38 to 4.25) in the past 30 days had higher odds of reporting ever vaping cannabis compared with their counterparts. There was no significant association between use of smokeless tobacco (aOR 0.89, 95% CI 0.42 to 1.91) or use of cigarettes (aOR 1.27, 95% CI 0.71 to 2.29) in the past 30 days and odds of reporting ever vaping cannabis. CONCLUSIONS:These findings provide evidence that large numbers of high school students who use tobacco products have vaped cannabis. As tobacco control policies-such as communication campaigns or smoke-free laws-increasingly focus on e-cigarettes, attention to understanding how adolescents use e-cigarettes to vape substances other than nicotine is essential.
Project description:There is growing evidence that an adolescent's decision to try cigarettes is influenced by level of exposure to movies in which smoking is portrayed. Less is known about how ethnicity affects this process. We examined whether acculturation and/or country of birth influence the relationship between exposure to smoking imagery in the movies and experimenting with cigarettes among Mexican origin youth. We prospectively followed 1,328 Mexican origin adolescents ages 11 to 13 years at baseline. We assessed which of 50 movies (randomly selected from a pool of 250 popular contemporary movies released from 1999 to 2004 and content analyzed for smoking) adolescents had seen. Smoking behavior was assessed at baseline and at 6-month intervals over 24 months. Ten percent of the adolescents had experimented at baseline; 17% tried subsequently. Multivariate analyses revealed, as exposure to smoking imagery in the movies increased, the chances of having ever experimented [adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI), 1.10-1.48] and of being a new experimenter (AOR = 1.19; 95% CI, 1.01-1.40) increased, equivalent to a 4.2% increased risk of ever and a 3.0% increased risk of new experimenting for each additional quartile of movie exposure. This effect was moderated by country of birth. For Mexican-born youth, exposure to smoking imagery in the movies was the strongest independent predictor of new experimentation (AOR = 1.52; 95% CI, 1.14-2.05). For U.S.-born youth, we observed a ceiling effect: the percent of experimenters increased with increasing exposure, and then flattened. Among Mexican-born youth, exposure to smoking imagery in the movies may be an important part of the acculturation process associated with smoking initiation.
Project description:E-cigarettes are the most commonly used tobacco product among youth. In addition to harm potential, e-cigarette use is associated with initiating cigarette smoking. Limited research exists whether susceptibility to e-cigarette use is a risk factor for future tobacco and other substance use initiation. This study examined associations between baseline e-cigarette susceptibility and initiation and past 30-day use of e-cigarettes and cigarettes as well as initiation of marijuana and alcohol one year later, after adjusting for other risk factors and sociodemographic confounders. The study sample consisted of 5156 nationally representative youth (12-17?years) who completed both waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health (PATH) study and were never users of tobacco, marijuana, and alcohol in Wave 1. Youth who were susceptible to e-cigarettes had increased odds of initiating e-cigarettes (adjusted OR: 2.22, 95% CI: 1.55-3.18), marijuana (aOR: 1.66, 95% CI: 1.12-2.46), and alcohol (aOR: 1.61, 95% CI: 1.26-2.06) between waves, as well as past reporting 30-day e-cigarette use (aOR: 3.64, 95% CI: 1.93-6.89) in Wave 2. Additionally, cigarette susceptibility, but not e-cigarette susceptibility, was associated with cigarette initiation (aOR: 3.36, 95% CI: 1.95-5.82) and past 30-day use (aOR: 2.83, 95% CI: 1.34-5.97). Prevention policies, as well as future research, could target youth susceptible to e-cigarettes to reduce the current trends on the use of these alternative tobacco products. Such efforts may also reduce the use of cigarettes and other substances.
Project description:Abstract <h4>Introduction</h4> The use of electronic cigarettes (vaping), especially with marijuana, has become increasingly popular among adults. <h4>Aims and Methods</h4> The Population Assessment of Tobacco and Health study Wave 4 data on 33 606 adult participants who indicated ever using electronic cigarettes were included in the study. By controlling for confounding variables (such as age and smoking history), multivariable weighted logistic regression models were used to examine the cross-sectional association between lifetime e-cigarette use with or without marijuana and self-reported past 12-month respiratory symptoms as well as lifetime respiratory diseases. <h4>Results</h4> Compared to adults who never vaped, adults who had ever vaped with marijuana had a significantly higher association with self-reported past 12-month respiratory symptoms but not lifetime respiratory diseases. Compared to adults who had ever vaped without marijuana, adults who had ever vaped at least sometimes with marijuana had a significantly greater risk of having wheezing/whistling in the chest (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI]: 1.01, 1.44), chest sounded wheezy during or after exercise (aOR = 1.59, 95% CI: 1.31, 1.93), and had a dry cough at night (aOR = 1.35, 95% CI: 1.16, 1.57), while adults who had ever vaped rarely with marijuana had a significantly greater risk of having wheezing/whistling in the chest (aOR = 1.31, 95% CI: 1.06, 1.61), chest sounded wheezy during or after exercise (aOR = 1.24, 95% CI: 1.01, 1.52), and had a dry cough at night (aOR = 1.24, 95% CI: 1.04, 1.47). <h4>Conclusions</h4> Lifetime e-cigarette use with marijuana is associated with self-reported past 12-month respiratory symptoms in adults. <h4>Implications</h4> The use of e-cigarettes with marijuana has become prevalent in recent years. Our cross-sectional study suggests that there may be respiratory health symptoms associated with ever vaping with marijuana that is independent of nicotine vaping, which should raise public awareness of potential health risks associated with the use of e-cigarettes with marijuana. Further longitudinal studies on the respiratory health effects of e-cigarette use with marijuana are warranted.
Project description:(1) Background: Characteristics and usage patterns of vapers (e-cigarette users) have mainly been studied in web-based convenience samples or in visitors of brick-and-mortar vape shops. We extended this by targeting customers of one particular online vape shop in the Netherlands; (2) Methods: Customers were questioned on their smoking history, current smoking and vaping status, reasons for vaping, perceived harmfulness, and potential health changes due to vaping; (3) Results: Almost everyone (99%, 95% CI 0.96, 1.00) smoked before they started vaping. A great majority agreed that unlike with other smoking-cessation aids, they could quit smoking (81%, 95% CI 0.79, 0.90) due to vaping. Almost all customers were regular vapers (93.6%, 95% CI 0.89, 0.96) who used state-of-the-art open system devices without modifications and e-liquid with 10 mg/mL nicotine on average. Vapers reported using e-cigs to quit smoking, because e-cigs are healthier, and for financial reasons. The majority (52.6%, 95% CI 0.46, 0.60) perceived vaping as not that harmful to not harmful at all, but one fifth (21.8%, 95% CI 0.16, 0.28) believed vaping to be harmful. More than half (57.8%, 95% CI 0.50, 0.65) reported gaining more pleasure from vaping than from smoking. A substantial majority (84.2%, 95% CI 0.78, 0.89) agreed that their health had improved since they started vaping; (4) Conclusions: Findings are similar to those obtained in other vape shop studies, but also to the results of convenience samples of less-well-defined populations.
Project description:Introduction:The use of electronic vapor products (EVPs) among youth has increased significantly in recent years, yet little is known about factors associated with initiation of EVPs during early adolescence. The purpose of this study was to explore the relationship between chronic exposure to adverse childhood experiences (ACEs) and early initiation of EVPs in a representative sample of middle school students. Methods:5,464 students from 113 middle schools (grades 6-8) completed the Nevada Youth Risk Behavior Survey (YRBS) in the spring of 2017. Six abuse and household dysfunction measures were used to calculate a cumulative ACE score (range 0-6). Initiation of EVPs (e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens) before age 11 was considered early initiation. Weighted logistic regression was used to assess the relationship between cumulative ACE exposure and early initiation of EVPs after controlling for sex, age, race/ethnicity, rurality, free or reduced lunch status, and military family involvement. Results:Nearly 1 in 5 middle school students (18.6%) reported using EVPs, 6.7% had used EVPs during the past 30 days, and 5.1% started using EVPs before age 11. After controlling for sociodemographics, a strong graded relationship between cumulative ACE exposure and early initiation of EVPs was observed: 1 ACE (AOR = 1.60; 95% CI = 0.99-2.59), 2 ACEs (AOR = 2.29; 95% CI = 1.33-3.93), and 3-6 ACEs (AOR = 3.43, 95% CI = 2.20-5.36) compared to no ACEs. Conclusions:Screening for ACEs in school-based settings may be a feasible approach for identifying students who may be at-risk for early initiation of EVPs.
Project description:BACKGROUND:An outbreak of E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) with significant morbidity and mortality was reported in 2019. While most patients with EVALI report vaping tetrahydrocannabinol (THC) oils contaminated with vitamin E acetate, a subset report only vaping with nicotine-containing electronic cigarettes (e-cigs). Whether or not e-cigs cause EVALI, the outbreak highlights the need for identifying long term health effects of e-cigs. EVALI pathology includes alveolar damage, pneumonitis and/or organizing pneumonia, often with lipid-laden macrophages (LLM). We assessed LLM in the lungs of healthy smokers, e-cig users, and never-smokers as a potential marker of e-cig toxicity and EVALI. METHODS:A cross-sectional study using bronchoscopy was conducted in healthy smokers, e-cig users, and never-smokers (n = 64). LLM, inflammatory cell counts, and cytokines were determined in bronchial alveolar fluids (BAL). E-cig users included both never-smokers and former light smokers. FINDINGS:High LLM was found in the lungs of almost all smokers and half of the e-cig users, but not those of never-smokers. LLM were not related to THC exposure or smoking history. LLM were significantly associated with inflammatory cytokines IL-4 and IL-10 in e-cig users, but not smoking-related cytokines. INTERPRETATION:This is the first report of lung LLM comparing apparently healthy smokers, e-cig users, and never-smokers. LLM are not a specific marker for EVALI given the frequent positivity in smokers; whether LLMs are a marker of lung inflammation in some e-cig users requires further study. FUNDING:The National Cancer Institute, the National Heart, Lung, and Blood Institute, the Food and Drug Administration Center for Tobacco Products, the National Center For Advancing Translational Sciences, and Pelotonia Intramural Research Funds.
Project description:BACKGROUND:Cigarettes share a high rate of co-use with alcohol, particularly among young adults. Studies have demonstrated greater perceived pleasure from smoking cigarettes when drinking alcohol. However, little is known about co-use of electronic cigarettes (e-cigs) and alcohol. The current study sought to compare extent of use and perceived pleasure from cigarettes and e-cigs when drinking alcohol. METHODS:Young adult bar patrons in California cities (San Diego, Los Angeles, and San Francisco) were recruited in 2015-16 using randomized time-location sampling. Participants completed cross-sectional surveys in bars, reporting the percent of cigarette smoking/e-cig use that occurred under the influence of alcohol, and reported if pleasure from smoking cigarettes/using e-cigs changed when drinking alcohol. Analyses are limited to participants reporting current (past 30-day) use of cigarettes, e-cigs, and alcohol (N?=?269; M age?=?24.1; 40.1% female, 36.1% Non-Hispanic White). RESULTS:Participants reported a greater percentage of cigarette smoking compared to e-cig use under the influence of alcohol (cigarettes M?=?63.6%; e-cigs M?=?46.7%; p?<?.001). Participants also reported increased pleasure both from smoking cigarettes (M?=?3.9; [compared to midpoint of scale 3 - "no change"] p?<?.001) and using e-cigs (M?=?3.3; p?<?.001) when drinking alcohol. The increase in pleasure was more pronounced for cigarettes compared to e-cigs (p?<?.001). CONCLUSIONS:Drinking alcohol is associated with increases in perceived rewarding effects of both cigarettes and e-cigs and thus may increase their abuse liability. This effect may be stronger for cigarettes, which could be an important barrier to switching completely from smoking cigarettes to using e-cigs, or quitting both entirely.