Ashley Sanders-Jackson

Sociodemographic correlates of self-reported exposure to e-cigarette communications and its association with public support for smoke-free and vape-free policies: results from a national survey of US adults

Background Exposure to e-cigarette communications (eg, advertisements, news and entertainment media, and interpersonal discussion) may influence support for smoke-free or vape-free policies. This study examined the sociodemographic correlates of self-reported exposure to e-cigarette communications and their relationships with support for restricting vaping and smoking in public venues. Method Online survey data was collected from a representative sample of US adults (n=1449) between October and December 2013 (mean age=50 years, 51% female, 8% African-American, 10% Hispanic, 6% other races) and weighted to match the US adult population. We fitted multiple regression models, adjusting for demographic variables, to examine associations between support for policies to restrict vaping and smoking in public venues and self-reported frequency of exposure to e-cigarette communications in the preceding month. We fitted separate models to assess associations between policy support and frequency of exposures weighted by whether each category of e-cigarette communications was perceived as positive or negative. Results Higher self-reported exposure to advertising (B=−0.022, p=0.006), other media (B=−0.022, p=0.043) and interpersonal discussion (B=−0.071, p<0.0005) perceived as positive were associated with lower support for vaping restrictions, adjusting for covariates. Exposure to e-cigarette communications was associated with lower support for smoking restrictions in bivariate analyses but was not significant after adjusting for covariates. Conclusions Further research is needed to assess whether messages portraying e-cigarettes as a way to circumvent smoking restrictions from advertisements and other media are influencing public support for vape-free policies. These findings provide empirical evidence to inform the policy debate over regulating specific e-cigarette advertising claims.

Convenience store visits by US adolescents: Rationale for healthier retail environments

Given interest in the public health impact of convenience stores, it is surprising that so little is known about the popularity of these destinations for youth. We surveyed 2772 adolescents (age 13-16) from a nationally representative web panel of US households. Nearly half (47.5%) of adolescents reported visiting convenience stores at least weekly. Significant risk factors for frequent visits were age, being African-American, living in rural areas and in areas with higher levels of neighborhood deprivation. With approximately 4.1 million US adolescents visiting convenience stores at least weekly, new policies and other interventions are needed to promote a healthier retail environment for youth.

Perceived harm of secondhand electronic cigarette vapors and policy support to restrict public vaping: Results from a national survey of US adults

INTRODUCTION There is ongoing debate over banning electronic cigarette (e-cigarette) use (vaping) in public places. Many people perceive secondhand e-cigarette vapors (SHV) to be relatively harmless, which may affect their support for policies to restrict vaping in public places. Given that awareness of secondhand cigarette smoke risks predicts public support for clean air policies, we hypothesized that greater perceived harm of SHV to personal health would be associated with stronger support for vaping restrictions. METHODS Data from 1449 US adults in a national online panel was collected from October to December 2013. Using multiple regressions, we predict a three-item scale of support for e-cigarette restricting policies in restaurants, bars/casinos/clubs, and parks using a two-item scale measuring concern and perceptions of harm to personal health from breathing SHV. Analyses adjusted for demographic covariates, smoking status and e-cigarette use, and were weighted to represent the US adult population. RESULTS Overall, respondents considered SHV exposure to be moderately harmful to their health and tended to favor restricting vaping in public places. Perceived harm of SHV to personal health was associated with support for vaping restrictions in public spaces (unstandardized regression coefficient, B = 0.18, 95% CI = 0.16, 0.20). Current smokers (vs. nonsmokers), those who ever tried e-cigarettes (vs. never), those who directly observed others vaping, and those with some college education (vs. high school or less) demonstrated less support for such policies. IMPLICATIONS This study shows that support for banning vaping in public spaces in the United States is positively associated with perceived health harms of SHV exposure. The findings suggest that continued monitoring of public perception of SHV harm and the accuracy of e-cigarette marketing claims about reduced harm would be needed to guide clean air policy decisions. With the emergence of new scientific evidence of the potential effects of SHV exposure, these results will serve as an important baseline of public perceptions and opinion during a time when such evidence was particularly limited.

Is exposure to e-cigarette communication associated with perceived harms of e-cigarette secondhand vapour? Results from a national survey of US adults

Objectives E-cigarettes are frequently advertised and portrayed in the media as less harmful compared with regular cigarettes. Earlier surveys reported public perceptions of harms to people using e-cigarettes; however, public perceptions of harms from exposure to secondhand vapour (SHV) have not been studied. We examined associations between self-reported exposure to e-cigarette advertising, media coverage, and interpersonal discussion and perceived harms of SHV. Design Observational study. Setting National online sample of US adults aged ≥18 years. Participants 1449 US adults (mean age 49.5 years), 51.3% female, 76.6% non-Hispanic Caucasian, 7.5% African-American, 10.0% Hispanic and 5.9% other races. Outcomes Perceived harm measures included (1) harmfulness of SHV to ones health, (2) concern about health impact of breathing SHV and (3) comparative harm of SHV versus secondhand smoke (SHS). Predictors were (1) self-reported frequency of exposure to e-cigarette advertising, media coverage and interpersonal discussion (close friends or family) and (2) perceived valence of exposure from each source. Covariates were demographic characteristics, cigarette smoking status and e-cigarette use, and were weighted to the general US adult population. Results More frequent interpersonal discussion was associated with lower perceived harmfulness of SHV to ones health and lower perceived comparative harm of SHV versus SHS. Frequency of e-cigarette ad and other media exposure were not significant predictors. Perceived negative valence of ad exposure and interpersonal discussion (vs no exposure) was associated with higher perceived harm across all three outcomes, while negative valence of media coverage was associated with higher concern about health impact of breathing SHV. Perceived positive valence (vs no exposure) of interpersonal discussion was associated with lower perceived harm across all three outcomes about health impact of breathing SHV. Conclusions Exposure to information about e-cigarettes through advertising, media coverage and interpersonal discussion could play a role in shaping public perceptions of the harmfulness of SHV.

Applying linguistic methods to understanding smoking-related conversations on Twitter

Introduction Social media, such as Twitter, have become major channels of communication and commentary on popular culture, including conversations on our nations leading addiction: tobacco. The current study examined Twitter conversations following two tobacco-related events in the media: (1) President Obama’s doctor announcing that he had quit smoking and (2) the release of a photograph of Miley Cyrus (a former Disney child star) smoking a cigarette. With a focus on high-profile individuals whose actions can draw public attention, we aimed to characterise tobacco-related conversations as an example of tobacco-related public discourse and to present a novel methodology for studying social media. Methods Tweets were collected 11–13 November 2011 (President Obama) and 1–3 August 2011 (Miley Cyrus) and analysed for relative frequency of terms, a novel application of a linguistic methodology. Results The President Obama data set (N=2749 tweets) had conversations about him quitting tobacco as well as a preponderance of information on political activity, links to websites, racialised terms and mention of marijuana. Websites and terms about Obama’s smoke-free status were most central to the conversation. In the Miley Cyrus data (N=4746 tweets), terms that occurred with the greatest relative frequency were positive, emotional and supportive of quitting (eg, love, and please), with words such as ‘love’ most central to the conversation. Conclusions People are talking about tobacco-related issues on Twitter, and semantic network analysis can be used to characterise on-line conversations. Future interventions may be able to harness social media and major current events to raise awareness of smoking-related issues.

Online Comments on Smoking Bans in Psychiatric Hospitals Units

Objective: Individuals with mental health concerns are disproportionately affected by and suffer the negative consequences of tobacco use disorder, perhaps because smoking has historically been part of psychiatrys culture. In the early 1990s, psychiatric inpatient facilities were exempted from U.S. hospital smoking bans, in response to public outcry with national media attention. Almost 2 decades later, the current study characterizes online conversation about psychiatric hospital smoking bans. Previous commenting studies have demonstrated commentings negativity, documenting the “nasty effect” wherein negative comments color perceptions of neutral articles. Thus, we focused particular attention on cited barriers to implementing health-positive smoke-free policies. Methods: We collected online comments (N = 261) responding to popular media articles on smoking bans in inpatient psychiatry between 2013 and 2014 and conducted an inductive and exploratory qualitative content analysis. Results: Verifying previous studies documenting the prevalence of negative commenting, of the comments explicitly supporting or refuting psychiatry smoking bans, there were over twice as many con comments (n = 44) than pro (n = 18). Many commenters argued for access to outdoor smoking areas and warned of patient agitation and risk posed to care workers. Identified content themes included psychiatric medication and negative side effects, broken mental health systems and institutions, denigration of the health risks of tobacco in the context of mental illness, typical pro-smoking arguments about “smokers’ rights” and alternatives (including e-cigarettes), addiction, and stigma. Conclusions: The current findings provide a platform to begin to understand how people talk about mental health issues and smoking. Our analysis also raised complex issues concerning forces that impact U.S. patients with serious mental illness but over which they have little control, including medication, the U.S. health system, stigma, perceptions that life with chronic serious mental illness is not worth living, and psychological and physical pain of coping with mental illness. In consideration of identified barriers raised in opposition to smoking bans in inpatient psychiatry, efforts should emphasize patient stakeholder involvement; patient, visitor, and staff protection from smoke exposure; the effectiveness of nicotine replacement for managing withdrawal; and the lack of evidence that cigarettes are therapeutic.

To Regulate or Not to Regulate? Views on Electronic Cigarette Regulations and Beliefs about the Reasons for and against Regulation

Background Policies designed to restrict marketing, access to, and public use of electronic cigarettes (e-cigarettes) are increasingly under debate in various jurisdictions in the US. Little is known about public perceptions of these policies and factors that predict their support or opposition. Methods Using a sample of US adults from Amazon Mechanical Turk in May 2015, this paper identifies beliefs about the benefits and costs of regulating e-cigarettes and identifies which of these beliefs predict support for e-cigarette restricting policies. Results A higher proportion of respondents agreed with 8 different reasons to regulate e-cigarettes (48.5% to 83.3% agreement) versus 7 reasons not to regulate e-cigarettes (11.5% to 18.9%). The majority of participants agreed with 7 out of 8 reasons for regulation. When all reasons to regulate or not were included in a final multivariable model, beliefs about protecting people from secondhand vapor and protecting youth from trying e-cigarettes significantly predicted stronger support for e-cigarette restricting policies, whereas concern about government intrusion into individual choices was associated with reduced support. Discussion This research identifies key beliefs that may underlie public support or opposition to policies designed to regulate the marketing and use of e-cigarettes. Advocates on both sides of the issue may find this research valuable in developing strategic campaigns related to the issue. Implications Specific beliefs of potential benefits and costs of e-cigarette regulation (protecting youth, preventing exposure to secondhand vapor, and government intrusion into individual choices) may be effectively deployed by policy makers or health advocates in communicating with the public.

Speaking up about Lighting up in Public: Examining Psychosocial Correlates of Smoking and Vaping Assertive Communication Intentions among U.S. Adults

ABSTRACT Against a backdrop of increasing smoke-free policies, electronic cigarette use, and discussion about public health risks posed by smoking and vaping, this study examines psychosocial predictors of intentions to ask others not to use e-cigarettes (vape) and smoke - i.e., assertive communication intentions. A national sample of U.S. adults (n = 474) reported assertive communication intentions for public venues. Psychosocial correlates included perceived risks of exposure to secondhand smoke (SHSe) and secondhand vapor (SHVe), SHSe and SHVe attitudes, subjective norms, and perceived self-efficacy. Separate linear regression models were conducted for smoking and vaping assertive communication intention outcomes. Perceived risks and self-efficacy were associated with greater vaping and smoking assertive communication intentions; subjective norms were only significant for vaping assertive communication intentions. Although a majority of respondents indicated they were unlikely to intervene to voice objections about SHSe and SHVe in public venues, this study suggests that incidental or intentional messages and policies that influence perceptions of risk, norms, and efficacy could affect willingness to voice objections about others’ vaping and smoking in public.

Effects of health-oriented descriptors on combustible cigarette and electronic cigarette packaging: an experiment among adult smokers in the United States

Objective Certain tobacco companies use health-oriented descriptors (eg, 100% organic) on product packaging and advertising of combustible cigarettes or electronic cigarettes (e-cigarettes) that create a ‘health halo’ around smoking and vaping. Previous observational research suggests that such language may be associated with more favourable attitudes and reduced risk perceptions toward these brands compared with others. This study aimed to determine the effects of health-oriented descriptors on smokers’ attitude toward the brand, perception of packaging information, comparative harm versus other brands and intention to purchase either combustible cigarettes or e-cigarettes. Method US adult smokers were randomly assigned to view either a health-oriented language package (‘100% organic,’ ‘all natural’ or ‘no additives’), traditional marketing language package (‘fine quality,’ ‘premium blend’ or ‘100% original’) or a no-language package of a combustible cigarette brand (Study 1, n=405) or an e-cigarette brand (Study 2, n=396) in an experimental design. Results Study 1: Participants in the health-oriented condition reported more favourable perceptions toward the package information, lower comparative harm and higher intention to purchase combustible cigarettes versus the no language control. In addition, participants in the health-oriented condition reported more positive attitude toward the brand and lower comparative harm versus the traditional marketing condition. Study 2: Compared with the traditional marketing condition, participants in the health-oriented condition reported greater intention to purchase Absolute e-cigarettes. There were no significant differences in attitude toward the brand, perception of packaging information and comparative harm versus other brands across conditions. Conclusions The effect of health-oriented language was significant for combustible cigarettesand e-cigarette packages. Policies to restrict health-oriented language on cigarette and e-cigarette packaging are recommended.

Effects of exposure to anti-vaping public service announcements among current smokers and dual users of cigarettes and electronic nicotine delivery systems

INTRODUCTION Anti-vaping public service announcements (PSAs) are intended to discourage vaping or use of electronic nicotine delivery systems (ENDS). However, vaping portrayals in PSAs may have unintended effects if they increase smoking or vaping urges. This study examined benefits and unintended effects of anti-vaping PSAs with vapor portrayals on smoking and vaping-related outcomes. METHODS Young adult smokers (N = 171) and dual users (N = 122) aged 21-30 years were randomly assigned to view: 1) anti-vaping PSAs with vapor; 2) anti-vaping PSAs without vapor; 3) physical activity PSAs; or 4) anti-smoking PSAs with smoking cues. Outcomes were changes in vaping and smoking urges before and after viewing PSAs, post-test vaping and smoking intentions in the next hour, and post-test intention to purchase ENDS and traditional cigarettes. RESULTS Smokers only: Exposure to anti-vaping PSAs with vapor (vs. physical activity) was associated with lower intention to vape and to purchase ENDS (ps < 0.001) and lower intention to smoke and purchase cigarettes (ps < 0.05). Exposure to anti-vaping PSAs with vapor (vs. PSAs without vapor and vs. anti-smoking PSAs with smoking cues) was associated with lower intention to vape in the next hour (ps < 0.05). Exposure to anti-vaping PSAs without vapor (vs. physical activity) was associated with lower change in vaping urge (p < 0.05) and intention to purchase ENDS (p < 0.001). Dual users: Exposure to anti-vaping PSAs without vapor (vs. anti-smoking PSAs) was associated with lower intention to purchase ENDS (p < 0.05). CONCLUSION Viewing anti-vaping PSAs with vapor was not associated with unintended effects and may have benefits on reducing smoking and vaping-related outcomes.