Erin Stratton

Perceived Harm, Addictiveness, and Social Acceptability of Tobacco Products and Marijuana Among Young Adults: Marijuana, Hookah, and Electronic Cigarettes Win

Background: There has been an increase in non-daily smoking, alternative tobacco product and marijuana use among young adults in recent years. Objectives: This study examined perceptions of health risks, addictiveness, and social acceptability of cigarettes, cigar products, smokeless tobacco, hookah, electronic cigarettes, and marijuana among young adults and correlates of such perceptions. Methods: In Spring 2013, 10,000 students at two universities in the Southeastern United States were recruited to complete an online survey (2,002 respondents), assessing personal, parental, and peer use of each product; and perceptions of health risks, addictiveness, and social acceptability of each of these products. Results: Marijuana was the most commonly used product in the past month (19.2%), with hookah being the second most commonly used (16.4%). The least commonly used were smokeless tobacco products (2.6%) and electronic cigarettes (4.5%). There were high rates of concurrent product use, particularly among electronic cigarette users. The most positively perceived was marijuana, with hookah and electronic cigarettes being second. While tobacco use and related social factors, related positively, influenced perceptions of marijuana, marijuana use and related social factors were not associated with perceptions of any tobacco product. Conclusions/Importance: Marketing efforts to promote electronic cigarettes and hookah to be safe and socially acceptable seem to be effective, while policy changes seem to be altering perceptions of marijuana and related social norms. Research is needed to document the health risks and addictive nature of emerging tobacco products and marijuana and evaluate efforts to communicate such risks to youth.

Attitudes toward E-Cigarettes, Reasons for Initiating E-Cigarette Use, and Changes in Smoking Behavior after Initiation: A Pilot Longitudinal Study of Regular Cigarette Smokers

Objectives We examined 1) changes in smoking and vaping behavior and associated cotinine levels and health status among regular smokers who were first-time e-cigarette purchasers and 2) attitudes, intentions, and restrictions regarding e-cigarettes. Methods We conducted a pilot longitudinal study with assessments of the aforementioned factors and salivary cotinine at weeks 0, 4, and 8. Eligibility criteria included being ≥18 years old, smoking ≥25 of the last 30 days, smoking ≥5 cigarettes per day (cpd), smoking regularly ≥1 year, and not having started using e-cigarettes. Of 72 individuals screened, 40 consented, 36 completed the baseline survey, and 83.3% and 72.2% were retained at weeks 4 and 8, respectively. Results Participants reduced cigarette consumption from baseline to week 4 and 8 (p’s < 0.001); 23.1% reported no cigarette use in the past month at week 8. There was no significant decrease in cotinine from baseline to week 4 or 8 (p’s = ns). At week 8, the majority reported improved health (65.4%), reduced smoker’s cough (57.7%), and improved sense of smell (53.8%) and taste (50.0%). The majority believed that e-cigarettes versus regular cigarettes have fewer health risks (97.2%) and that e-cigarettes have been shown to help smokers quit (80.6%) and reduce cigarette consumption (97.2%). In addition, the majority intended to use e-cigarettes as a complete replacement for regular cigarettes (69.4%) and reported no restriction on e-cigarette use in the home (63.9%) or car (80.6%). Conclusions Future research is needed to document the long-term impact on smoking behavior and health among cigarette smokers who initiate use of e-cigarettes.

Rules regarding Marijuana and Its Use in Personal Residences: Findings from Marijuana Users and Nonusers Recruited through Social Media

Recent changes in policy and social norms related to marijuana use have increased its use and concern about how/where marijuana should be used. We aimed to characterize rules regarding marijuana and its use in homes. We recruited 1,567 US adults aged 18–34 years through Facebook advertisements to complete an online survey assessing marijuana use, social factors, perceptions of marijuana, and rules regarding marijuana and its use in the home, targeting tobacco and marijuana users to ensure the relevance of this topic. Overall, 648 (41.6%) were current marijuana users; 46.0% of participants reported that “marijuana of any type is not allowed in their home or on their property.” Of those allowing marijuana on their property, 6.4% prohibited use of marijuana in their home. Of the remainder, 29.2% prohibited smoking marijuana, and 11.0% prohibited vaping, eating, or drinking marijuana. Correlates of more restrictive rules included younger age, being female, having <Bachelors degree, not having parents or people living with them who use marijuana, perceiving use to be less socially acceptable and more harmful, and being a nonuser (ps <.05). Attitudes and subjective norms regarding marijuana are correlates of allowing marijuana in residential settings. Future work should examine areas of risk regarding household marijuana rules.

Novel incentives and messaging in an online college smoking intervention.

OBJECTIVES To examine the feasibility, acceptability, and potential effectiveness of an online intervention targeting college smokers. The incentives involved discounted or free goods and services from businesses proximal to each campus. METHODS A randomized controlled trial was conducted with 122 current smokers recruited from 2 Southeastern US universities. The intervention involved health behavior monitoring, targeted messaging, and incentives for healthy goods and services versus the American Cancer Societys Guide to Quitting Smoking online. RESULTS The intervention achieved greater adherence and utilization (ps < .001). Overall, 55.6% learned about a local business through this program. At end-of-treatment, intervention participants less frequently attempted to quit (p = .02) but smoked fewer cigarettes/day (p = .05). Both groups demonstrated significant end-of-treatment cessation rates. CONCLUSIONS This intervention demonstrated feasibility and acceptability.

Pilot results of an online intervention targeting health promoting behaviors among young adult cancer survivors

Whereas the incidence of childhood cancer has increased, mortality has decreased [1], with 80% surviving long-term [1]. These survivors are at higher risk for health problems and early mortality [2]. Unfortunately, young adult survivors of childhood cancer are at risk for using alcohol, tobacco, and other drugs and for low physical activity and obesity [3]. Therefore, modifiable risk factors should be a focus for prevention interventions among this susceptible, high-risk population [4]. This group shows interest in programs targeting health behavior change [5]; however, they have several barriers to intervention (e.g., limited time/ resources) [5]. Technology-based (e.g., web-based or app-based) interventions, which have broad reach, may be appropriate for this group [6]. Unfortunately, engaging individuals in technology-based programs is a challenge [7]. One solution may be novel incentive structures. One way to provide incentives that are potentially sustainable is to model the incentives structure after popular programs already in existence; for example, Groupon® or LivingSocial® are websites that offer ‘daily deals’ among local businesses. They are growing in profit at high rates and in consumer spending [8]. Thus, we examined the feasibility and acceptability of a healthy lifestyle intervention targeting physical activity, alcohol use, and tobacco use among a small sample of young adult survivors of childhood cancers that included a novel incentive structure.

Sociodemographic, Psychosocial, and Health Behavior Risk Factors Associated with Sexual Risk Behaviors among Southeastern US College Students

Objectives We examined correlates of 1) being a virgin; 2) drug or alcohol use prior to the last intercourse; and 3) condom use during the last intercourse in a sample of college students. Methods We recruited 24,055 students at six colleges in the Southeast to complete an online survey, yielding 4840 responses (20.1% response rate), with complete data from 4514. Results Logistic regression indicated that correlates of virginity included being younger (p < 0.001), male (p = 0.01), being White or other ethnicity (p < 0.001), attending a four-vs. two-year school (p < 0.001), being single/never married (p < 0.001), lower sensation seeking (p < 0.001), more regular religious service attendance (p < 0.001), lower likelihood of smoking (p < 0.001) and marijuana use (p = 0.002), and less frequentdrinking (p < 0.001). Correlates of alcohol or drug use prior to most recent intercourse including being older (p = 0.03), being White (p < 0.01), attending a four-year college (p < 0.001), being homosexual (p = 0.041) or bisexual (p = 0.011), having more lifetime sexual partners (p = 0.005), lower satisfaction with life (p = 0.004), greater likelihood of smoking (p < 0.001) and marijuana use (p < 0.001), and more frequent drinking (p < 0.001). Correlates of condom use during the last sexual intercourse including being older (p = 0.003), being female (p < 0.001), being White (p < 0.001), attending a two-year school (p = 0.04), being single/never married (p = 0.005), being homosexual or bisexual (p = 0.04), and a more frequent drinking (p = 0.001). Conclusions Four-year college attendees were more likely to be a virgin but, if sexually active, reported higher sexual risk behaviors. These nuances regarding sexual risk may provide targets for sexual health promotion programs and interventions.