Clara G. Sears

Vape Shop Employees: Public Health Advocates?

INTRODUCTION E-cigarettes have increased in popularity and given rise to a new type of sales outlet—the vape shop. Expanding on work examining vape shop employee e-cigarette and tobacco attitudes and behaviors1, this study examined key messages that vape shop employees communicate to customers. METHODS Using informal interviews, observations, and a cross-sectional survey, we examined vape shop employees’ (n=16) perceptions and e-cigarette use. Data were collected in nine vape shops in Louisville, Kentucky. We used open coding to analyze the qualitative interviews, observation notes, and open-ended survey responses. Descriptive statistics were used to analyze survey data. RESULTS The findings revealed that nearly all employees were former smokers (93.8%), who now only use e-cigarettes. Over one-third of the employees (37.5%) began using e-cigarettes as a replacement for traditional cigarettes, and 93.8% reported better health (e.g., easier breathing, less coughing) since starting to use e-cigarettes. Although most employees believed e-cigarettes should be regulated, 56.3% thought regulations should be different from those governing traditional cigarettes. Analysis of qualitative data revealed that employees see themselves as health advocates who: 1) provide instructions on vaping and promote a vape community, 2) encourage cessation of traditional cigarettes, and 3) support some regulations. CONCLUSIONS The findings reveal that vape shop employees regard e-cigarettes as viable smoking cessation tools and relish their role in assisting others in taking what employees view as positive health actions. Future research addressing communication between vape shop employees and customers, especially related to smoking cessation and health, is needed.

Clean, Cheap, Convenient: Promotion of Electronic Cigarettes on YouTube

INTRODUCTION Videos promoting electronic cigarettes (e-cigarettes) can be easily accessed on YouTube. Marketing claims present in YouTube videos may help shape the public’s opinion of e-cigarettes. Thus, it is important to understand the most frequent marketing claims and video sources. METHODS The objectives of this study were to 1) identify marketing claims in YouTube videos that are commonly made on e-cigarette retail websites and 2) compare the frequency of marketing claims in user-generated and professional YouTube videos. Through content analysis, this study evaluated six marketing claims and descriptive information about YouTube videos (n = 50) related to “electronic cigarettes” and “vape”. RESULTS Overall, the most frequent marketing claim promoted e-cigarette use as better than traditional tobacco use (52%). Approximately 65% of videos appeared to be user-generated and 35% were professionally-produced. Compared to user-generated videos, significantly more professional videos made claims that e-cigarettes are cleaner (p < 0.001) and cheaper (p = 0.04) than traditional cigarettes. Additionally, more professional videos had claims promoting e-cigarettes as better than traditional cigarettes because of their convenience—the user can smoke anywhere (p < 0.0001) and the products do not produce secondhand smoke (p < 0.001). The most frequent claim in user-generated videos was related to recreation (53%). CONCLUSIONS Videos on YouTube promote e-cigarettes as safer than other tobacco products. Videos appearing to be user-generated contained different marketing claims compared to professional videos. Further research is necessary to assess how the perceived source of the video impacts the ways these marketing claims shape public perception and influence use.

A picture is worth a thousand words: Electronic cigarette content on Instagram and Pinterest

INTRODUCTION This study examined electronic cigarette (e-cig) content in visual materials posted on the social-media platforms Instagram and Pinterest. Both platforms allow users to upload pictures to the internet and share them globally. Users can search for pictures tagged with specific keywords and phrases. METHODS Using content analysis, this study identified themes in image postings of e-cigs on social media. During five weeks of data collection, keywords were used to identify pictures related to e-cigs. These pictures were then coded into one or more categories. RESULTS The three most popular categories for Instagram posts were marketing, customization and juices/flavors. The three most popular categories for Pinterest posts were customization, marketing and memes. CONCLUSIONS Because of the persuasive power of visuals, it is important to examine communication on Instagram and Pinterest as well as the specific visual messages communicated. Stores and manufacturers use these and similar platforms to communicate with users and potential users; thus it seems that marketers are capitalizing on opportunities for persuasive appeal. The results highlight the popularity of e-cig content on these two social media platforms and reveal an emphasis on marketing and customization.

Generally Recognized as Safe: Uncertainty Surrounding E-Cigarette Flavoring Safety

Despite scientific uncertainty regarding the relative safety of inhaling e-cigarette aerosol and flavorings, some consumers regard the U.S. Food and Drug Administration’s “generally recognized as safe” (GRAS) designation as evidence of flavoring safety. In this study, we assessed how college students’ perceptions of e-cigarette flavoring safety are related to understanding of the GRAS designation. During spring 2017, an online questionnaire was administered to college students. Chi-square p-values and multivariable logistic regression were employed to compare perceptions among participants considering e-cigarette flavorings as safe and those considering e-cigarette flavorings to be unsafe. The total sample size was 567 participants. Only 22% knew that GRAS designation meant that a product is safe to ingest, not inhale, inject, or use topically. Of participants who considered flavorings to be GRAS, the majority recognized that the designation meant a product is safe to ingest but also considered it safe to inhale. Although scientific uncertainty on the overall safety of flavorings in e-cigarettes remains, health messaging can educate the public about the GRAS designation and its irrelevance to e-cigarette safety.

Health of Children Living Near Coal Ash

Coal ash, generated from coal combustion, is composed of small particles containing metals and other elements, such as metalloids. Coal ash is stored in open-air impoundments, frequently near communities. The objective of this study was to evaluate the prevalence of health and sleep problems in children living near coal ash and compare these prevalences to children not living near coal ash. In 2013 to 2014, we conducted a cross-sectional survey in a community adjacent to coal ash storage sites and a community not exposed to coal ash. Overall, 111 children who lived near coal ash were in the study; 55.9% (62) were males, 44.1% (49) were females, and the mean age was 10.3 years (SD = 3.9). Descriptive statistics and logistic regression were used to compare the prevalence of health and sleep problems. Attention-deficit hyperactivity disorder (P = .02), gastrointestinal problems (P = .01), difficulty falling asleep (P = .007), frequent night awakenings (P < .001), teeth grinding (P = .03), and complaint of leg cramps (P < .001) were significantly greater in the children living near coal ash. When adjusting for covariates, the odds of allergies excluding asthma, attention-deficit hyperactivity disorder, gastrointestinal problems, difficulty falling asleep, frequent night awakenings, sleep talking, and complaint of leg cramps were greater in children living near coal ash compared to children not living near coal ash (nonexposed). Several components of coal ash, such as heavy metals like lead, mercury, and arsenic, may be associated with health and sleep problems in children. More research is needed to investigate this relationship.

Exposure-Reducing Behaviors Among Residents Living Near a Coal Ash Storage Site

Coal ash, a waste product generated from burning coal for energy, is composed of highly respirable particles containing heavy metals, radioactive elements, and polycylic aromatic hydrocarbons. Coal ash is stored in landfills and surface impoundments frequently located near neighborhoods. Fugitive dust from the storage sites exposes neighborhoods, affecting the health and welfare of residents. The research questions of interest were (1) are community members concerned about coal ash exposure from the storage site; (2) what, if any, behaviors do community members engage in to reduce exposure; and (3) do exposure reducing behaviors differ by level of concern about coal ash. A community-based mixed-methods approach was used. Focus groups (n = 26) were conducted in 2012, and a cross-sectional survey was administered in 2013 (n = 231). The majority of survey respondents (62%) worried “a lot” about being exposed to coal ash; however, most did not engage in exposure-reducing behaviors, such as wearing protective equipment when doing chores. Compared with respondents who worry “some, very little, or none,” or responded “I don’t know,” respondents who worried “a lot” about being exposed to coal ash did more exposure-reducing behaviors outdoors (p < .001) and indoors (p = .01). For people living near environmental hazards, reducing exposure is a priority. Although challenging because of the chronic nature of exposure, some behaviors can be useful in reducing exposure, such as wearing a particle-specific respirator when mowing the lawn. Communities at risk for chronic exposure to environmental toxins could benefit from education about exposure-reducing behaviors.

The ‘state’ of tobacco: Perceptions of tobacco among Appalachian youth in Kentucky

INTRODUCTION In Appalachia, youth tobacco-use rates remain higher than the U.S. national average. Past research has indicated that several factors are related to high rates of tobacco use among Appalachian youth (e.g. low socioeconomic status, rural lifestyles). Of the Appalachian states, Kentucky has one of the highest rates of youth tobacco use. The aim of this study was to explore views of tobacco among Kentucky youth living in Appalachian counties. METHODS In Fall 2014 - Spring 2015, focus group interviews were conducted with middle and high school students (N=109) in Appalachian counties in Kentucky. Each focus group session included open-ended questions and was conducted by trained facilitators. Focus group transcriptions and field notes were analyzed for themes. RESULTS Study participants described an entrenched culture of tobacco. Three themes exemplified this culture. First, adult behavior served to enable youth tobacco use (e.g. teachers ignoring dip use in class, adults smoking with youth). Second, tobacco is easily accessible to youth (e.g. restrictions on youth sales are often ignored, family members provide). Third, symbols of tobacco are prevalent (e.g. festivals celebrating tobacco heritage, tobacco barns, and tobacco marketing logos). CONCLUSIONS Youth participants described a deeply rooted tobacco culture, which they believed was unlikely to change. Additional studies and health education efforts are needed in these rural communities. Further, stricter enforcement of tobacco sales and marketing restrictions may be helpful in protecting this vulnerable population.

E-cigarette use and perceived health change: Better healththrough vaping?

INTRODUCTION As e-cigarette use increases, questions about individual and public health effects remain unanswered (e.g. cessation tool, addiction path). Despite increasing use, few studies have focused on vape shop patrons. This study examined whether vape shop patrons believe their health is affected by the use of e-cigs; more specifically, the aim was to evaluate the association between e-cig use, change in tobacco use, and perception of health. METHODS A survey of e-cig users (N=78) was conducted in vape shops. Questions included e-cig and traditional tobacco use, health perceptions, and demographics. Descriptive techniques were used to characterize participants as either those who perceived e-cig use improved their health or those who perceived their health unaffected. Logistic regression assessed the association between change in tobacco use, e-cig use, and perception of health effects. RESULTS Most reported daily e-cig (91%) and current (11.5%) or former (78.2%) combustible cigarette use. Approximately, three-fourths (76.9%) perceived better health; the remainder (23.1%) perceived unaffected health. Change in cigarette use was significantly associated with perceptions that health is better with e-cig use. Participants who decreased cigarette use by 2–3 cartons/month and more than 3 cartons/month were significantly more likely to indicate that e-cig use has improved their health compared to those who decreased tobacco use by 1.5 cartons or fewer per month (OR=4.35, 95% CI: 1.13–16.9; OR=25.67, 95% CI: 2.97–221.7, respectively). CONCLUSIONS The majority of e-cig users perceived better health. Our findings suggest that health campaign designers should carefully assess the scientific uncertainty surrounding the use of these devices and consider means to clearly convey this information. Given the lack of scientific agreement on the health effects of e-cigs and the important role that perceptions play in behavior, health campaign designers, health education practitioners, policy makers, and health care providers should err on the side of caution when advising individuals about e-cig use.