Amanda Richardson

e-Cigarette Awareness, Use, and Harm Perceptions in US Adults

OBJECTIVES We estimated e-cigarette (electronic nicotine delivery system) awareness, use, and harm perceptions among US adults. METHODS We drew data from 2 surveys conducted in 2010: a national online study (n = 2649) and the Legacy Longitudinal Smoker Cohort (n = 3658). We used multivariable models to examine e-cigarette awareness, use, and harm perceptions. RESULTS In the online survey, 40.2% (95% confidence interval [CI] = 37.3, 43.1) had heard of e-cigarettes, with awareness highest among current smokers. Utilization was higher among current smokers (11.4%; 95% CI = 9.3, 14.0) than in the total population (3.4%; 95% CI = 2.6, 4.2), with 2.0% (95% CI = 1.0, 3.8) of former smokers and 0.8% (95% CI = 0.35, 1.7) of never-smokers ever using e-cigarettes. In both surveys, non-Hispanic Whites, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes. CONCLUSIONS Awareness of e-cigarettes is high, and use among current and former smokers is evident. We recommend product regulation and careful surveillance to monitor public health impact and emerging utilization patterns, and to ascertain why, how, and under what conditions e-cigarettes are being used.

Tobacco on the web: surveillance and characterisation of online tobacco and e-cigarette advertising

Background Despite the internets broad reach and potential to influence consumer behaviour, there has been little examination of the volume, characteristics, and target audience of online tobacco and e-cigarette advertisements. Methods A full-service advertising firm was used to collect all online banner/video advertisements occurring in the USA and Canada between 1 April 2012 and 1 April 2013. The advertisement and associated meta-data on brand, date range observed, first market, and spend were downloaded and summarised. Characteristics and themes of advertisements, as well as topic area and target demographics of websites on which advertisements appeared, were also examined. Results Over a 1-year period, almost

Flavored Tobacco Product Use Among U.S. Young Adults

2 million were spent by the e-cigarette and tobacco industries on the placement of their online product advertisements in the USA and Canada. Most was spent promoting two brands: NJOY e-cigarettes and Swedish Snus. There was almost no advertising of cigarettes. About 30% of all advertisements mentioned a price promotion, discount coupon or price break. e-Cigarette advertisements were most likely to feature messages of harm reduction (38%) or use for cessation (21%). Certain brands advertised on websites that contained up to 35% of youth (<18 years) as their audience. Conclusions Online banner/video advertising is a tactic used mainly to advertise e-cigarettes and cigars rather than cigarettes, some with unproven claims about benefits to health. Given the reach and accessibility of online advertising to vulnerable populations such as youth and the potential for health claims to be misinterpreted, online advertisements need to be closely monitored.

Noncombustible tobacco product advertising: how companies are selling the new face of tobacco.

BACKGROUND Passage of the U.S. Family Smoking Prevention and Tobacco Control Act in 2009 led to a ban on the sale of flavored cigarettes, largely because of studies showing targeting of these products to youth and young adults. There are no current restrictions on the marketing or sale of noncigarette or new nontraditional smokeless tobacco products (such as snus and dissolvable products), which are available in more than 45 flavors. PURPOSE To determine the prevalence of flavored tobacco use, dual use of flavored and menthol tobacco products, and sociodemographic predictors of flavored tobacco product use in young adults aged 18-34 years (N=4196). METHODS The current study utilizes data from Legacys Young Adult Cohort Study, a nationally representative sample collected in January 2012. Data were analyzed using Stata IC 11.0 in June 2012. RESULTS Overall, 18.5% of tobacco users report using flavored products, and dual use of menthol and flavored product use ranged from 1% (nicotine products) to 72% (chewing tobacco). In a multivariable model controlling for menthol use, younger adults were more likely to use flavored tobacco products (OR=1.89, 95% CI=1.14, 3.11), and those with a high school education had decreased use of flavored products (OR=0.56; 95% CI=0.32, 0.97). CONCLUSIONS Differences in use may be due to the continued targeted advertising of flavored products to young adults and minorities. Those most likely to use flavored products are also those most at risk of developing established tobacco-use patterns that persist through their lifetime.

Engagement Promotes Abstinence in a Web-based Cessation Intervention: Cohort Study

BACKGROUND With declining cigarette sales, increasing restrictions, and recent Food and Drug Administration (FDA) regulation of cigarettes, there has been a dramatic rise in the marketing of noncombustible tobacco products (NCPs). However, little is known about how NCPs are advertised and to whom. METHODS Two full-service advertising firms were used to systematically collect all U.S. advertisements for NCPs (e-cigarettes, snus, dissolvables, and chew/dip/snuff,) running between June 1 and September 1, 2012. The advertisement and associated metadata (brand, media channel, observations, spend, and estimated reach) were examined. Attributes of print advertisements were examined relative to target demographics of the publications in which they ran. RESULTS Over 3 months, almost

The Next Generation of Users: Prevalence and Longitudinal Patterns of Tobacco Use Among US Young Adults

20 million was spent advertising NCPs. Although the greatest amount spent was on the promotion of smokeless (~

Prevalence, harm perceptions, and reasons for using noncombustible tobacco products among current and former smokers.

8 million) and snus (~

The association between alcohol, marijuana use, and new and emerging tobacco products in a young adult population.

10 million), e-cigarette advertisements were the most widely circulated. Print advertisements, the majority of which were e-cigarettes and chew/dip/snuff, were heavily tailored to middle-aged White males. Many e-cigarette print ads suggested harm reduction and use when one cannot smoke (poly-use), while chew/dip/snuff focused on masculinity. CONCLUSIONS Robust ongoing surveillance of NCP advertising is critical to inform the FDA and to protect public health. Both commercial advertising and public health media campaigns must ensure that content is not misleading and that it educates consumers about harm based on the available science. The way messages are framed have the potential to decrease tobacco use by promoting rather than undermining cessation of combusted products and/or by encouraging exclusive use of less harmful NCPs rather than poly-use of combusted and NCPs.

Effects of Race/Ethnicity and Socioeconomic Status on Health Information-Seeking, Confidence, and Trust

Background Web-based smoking cessation interventions can have a public health impact because they are both effective in promoting cessation and can reach large numbers of smokers in a cost-efficient manner. Their potential impact, however, has not been realized. It is still unclear how such interventions promote cessation, who benefits most, and how to improve their population impact. Objective To examine the effectiveness of a highly promoted Web-based smoking cessation intervention to promote quit behavior over time, identify the most effective features, and understand who is most likely to use those features by using unweighted and weighted analyses to estimate the impact in the broader pool of registered site users. Methods A sample of 1033 new adult registrants was recruited from a Web-based smoking cessation intervention by using an automated study management system. Abstinence was assessed by self-report through a mixed-mode follow-up (online survey with telephone follow-up for nonrespondents) at 1, 3, and 6 months. Software tracked respondents’ online activity. Generalized estimating equations (GEE) were used to examine predictors of website utilization and how utilization promoted abstinence using unweighted and weighted data. Results The 7-day point prevalence abstinence rates at 6 months ranged from 20.68% to 11.13% in the responder and intent-to-treat samples, respectively. Predictors of abstinence in unweighted analyses included number of visits to the website as well as accessing specific interactive or engaging features. In weighted analyses, only number of visits was predictive of abstinence. Motivation to quit was a key predictor of website utilization, whereas negative partner support decreased the likelihood of increasing visits or accessing engaging features. Conclusions Engagement is critical to promoting smoking cessation. The next generation of Web-based smoking cessation interventions needs to maximize the initial engagement of all new visitors and work to retain those smokers who proceed to register on the site.

Primary and Dual Users of Cigars and Cigarettes: Profiles, Tobacco Use Patterns and Relevance to Policy

OBJECTIVES We monitored the prevalence and patterns of use of the array of tobacco products available to young adults, who are at risk for initiation and progression to established tobacco use. METHODS We used data from waves 1 to 3 of GfKs KnowledgePanel (2011-2012), a nationally representative cohort of young adults aged 18 to 34 years (n = 2144). We examined prevalence and patterns of tobacco product use over time, associated demographics, and state-level tobacco policy. We used multivariable logistic regression to determine predictors of initiation of cigarettes as well as noncombustible and other combustible products. RESULTS The prevalence of ever tobacco use rose from 57.28% at wave 1 to 67.43% at wave 3. Use of multiple products was the most common pattern (66.39% of tobacco users by wave 3). Predictors of initiation differed by product type and included age, race/ethnicity, policy, and use of other tobacco products. CONCLUSIONS Tobacco use is high among young adults and many are using multiple products. Efforts to implement policy and educate young adults about the risks associated with new and emerging products are critical to prevent increased initiation of tobacco use.