Johannes Thrul

Community-level adult daily smoking prevalence moderates the association between adolescents' cigarette smoking and perceived smoking by friends.

Few studies have investigated the complex interactions among the individual- and community-level social risk factors that underlie adolescents’ smoking behaviors. This study investigated whether community-level adult daily smoking prevalence is associated with adolescents’ smoking and whether it moderates the associations between perceived friends’ smoking approval and smoking behavior and adolescents’ own smoking. Self-reported data from 1,190 youths (50.3xa0% female; 13–18xa0years old) in 50 midsized Californian cities were obtained through telephone interviews. Community characteristics were obtained from 2010 GeoLytics data. Community adult daily smoking prevalence was ascertained from telephone interviews with 8,918 adults conducted in the same 50 cities. Multilevel analyses, controlling for individual and city characteristics, were used to predict adolescents’ past 12-month smoking from perceived friends’ smoking approval and smoking behavior and from community adult daily smoking prevalence. Results showed that perceived friends’ smoking approval and behavior were associated positively with adolescents’ smoking, as was the community-level prevalence of adult daily smoking. Furthermore, the association between perceived friends’ smoking behavior and adolescents’ own smoking was moderated by the prevalence of adult daily smokers in the community. Specifically, the association was stronger in cities with higher prevalence of adult smokers. These results suggest that adult community norms that are more supportive of smoking may enhance the influence of friends’ smoking behavior. Therefore, interventions designed to prevent or reduce youths’ smoking should also focus on reducing smoking by adults.

A geographically explicit ecological momentary assessment (GEMA) mixed method for understanding substance use

Tobacco use is increasingly concentrated within marginalized groups, including LGBTQ+ young adults. Developing tailored interventions to reduce tobacco-related health disparities requires understanding the mechanisms linking individual and contextual factors associated with tobacco use to behavior. This paper presents an in-depth exploration of three cases from a novel mixed method study designed to identify the situational factors and place-based practices of substance use among high-risk individuals. We combined geographically explicit ecological momentary assessment (GEMA) with an adapted travel diary-interview method. Participants (young adult bisexual smokers, ages 18-26) reported on non-smoking and smoking situations for 30 days with a smartphone app. GEMA surveys captured internal and external situational factors (e.g., craving intensity, location type, seeing others smoking). Continuous locational data was collected via smartphone GPS. Subsequently, participants completed in-depth interviews reviewing maps of their own GEMA data. GEMA data and transcripts were analyzed separately and integrated at the case level in a matrix. Using GEMA maps to guide the interview grounded discussion in participants everyday smoking situations and routines. Interviews clarified participant interpretation of GEMA measures and revealed experiences and meanings of smoking locations and practices. The GEMA method identified the most frequent smoking locations/times for each participant (e.g., afternoons at university). Interviews provided description of associated situational factors and perceptions of smoking contexts (e.g., peer rejection of bisexual identity) and the roles of smoking therein (e.g., physically escape uncomfortable environments). In conclusion, this mixed method contributes to advancing qualitative GIS and other hypothesis-generating approaches working to reveal the richness of individuals experiences of the everyday contexts of health behavior, while also providing reliable measures of situational predictors of behaviors of interest, such as substance use. Limitations of and future directions for the method are discussed.

Momentary smoking context as a mediator of the relationship between SES and smoking

There is a well-established socioeconomic gradient in smoking behavior: those with lower socioeconomic status smoke more. However, much less is known about the mechanisms explaining how SES is linked to smoking. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behavior by differential exposure to places where smoking is allowed. Exposure to smoking restrictions was assessed in real-time using Ecological Momentary Assessment methods. A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether a smokers momentary context mediated the relationship between socioeconomic status (educational attainment) and cigarettes smoked per day (CPD). Momentary context was operationalized as the proportion of random assessments answered in locations where smoking was allowed versus where smoking was not allowed. Data were analysed using multilevel regression (measurements nested within participants) with a lower level mediation model (2-1-1 mediation). Although no significant direct effect of SES on CPD were observed, there was a significant indirect effect of SES on CPD via the momentary context. Compared to participants with higher education, lower educated participants were more likely to encounter places where smoking was allowed, and this in turn, was associated with a higher number of CPD. These findings suggest that SES is associated with smoking at least partially via differential exposure to smoking-friendly environments, with smokers from lower SES backgrounds accessing more places where smoking is allowed. Implications for current smoke-free legislation are discussed.

Just a First-Year Thing? The Relations between Drinking During Orientation Week and Subsequent Academic Year Drinking Across Class Years

ABSTRACT Background: The goal of Orientation Week is to help new students adjust to university life. However, it is a period when many new students engage in excessive alcohol consumption and where problematic drinking patterns may be established. Objective: The objective is to determine whether returning students drink in a similar manner to students in their first-year of classes and whether Orientation Week drinking predicts semester drinking more strongly for first-year than returning students. Methods: We tested 552 students (18 to 25 years old) in their first, second, or third class year of university. Students reported their Orientation Week drinking and then completed daily drinking diaries for 13 consecutive days during the academic year. Results: Orientation Week drinking was similar across class years and also predicted academic year drinking for students in all class years. Conclusion/Importance: Drinking during Orientation Week is not just a first-year problem and prevention efforts should focus on all students.

An Exploration of Smoking-to-Vaping Transition Attempts Using a “Smart” Electronic Nicotine Delivery System

IntroductionnElectronic nicotine delivery systems (ENDS) are used to aid smoking cessation attempts; however, many smokers continue to smoke while using an ENDS (dual use). Although uncertainty remains regarding whether specific ENDS patterns hinder or support successful smoking cessation, recent advances in smart technology allow passive and active recording of behaviors in real time, enabling more detailed insights into how smoking and vaping patterns may coevolve. We describe patterns of ENDS initiation, and subsequent use, including any changes in cigarette consumption, among daily smokers using a smart ENDS (S-ENDS) to quit smoking.nnnMethodnAn 8-week long mixed-methods feasibility study used Bluetooth-enabled S-ENDS that passively recorded real-time device use by participants (n = 11). Daily surveys administered via smartphones collected data on self-reported cigarette consumption.nnnResultsnAll 11 participants were dual users, at least initially, during their quit attempt. We observed three provisional vaping and smoking patterns: immediate and intensive ENDS initiation coupled with immediate, dramatic, and sustained smoking reduction, leading to smoking abstinence; gradual ENDS uptake with gradual smoking reductions, leading to daily dual use throughout the study period; and ENDS experimentation with return to exclusive smoking. For six participants, the patterns observed in week 1 were similar to the vaping and smoking patterns observed throughout the rest of the study period.nnnConclusionnTechnological advances now allow fine-grained description of ENDS use and smoking patterns. Larger and longer studies describing smoking-to-vaping patterns, and estimating associations with smoking outcomes, could inform ENDS-specific cessation advice promoting full transition from smoking to exclusive ENDS use.nnnImplicationsnThe use of an S-ENDS that recorded real-time device use among daily smokers engaged in a quit attempt provides insight into patterns and trajectories of dual use (continuing to smoke while using ENDS), and the possible associations between ENDS initiation, subsequent use, and smoking cessation outcomes. Such work could support more targeted cessation counseling and technical advice for smokers using ENDS to quit smoking, reduce the risk of users developing long-term dual use patterns, and enhance the contributions ENDS may make to reducing smoking prevalence.

Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study

BACKGROUNDnSexual minority young adults have higher smoking rates than the general young adult population, but reasons for this disparity are poorly understood. The current study aimed to: 1) identify real-time predictors of smoking among sexual minority and heterosexual smokers and 2) examine between-group differences in these predictors.nnnMETHODSnWe conducted an ecological momentary assessment (EMA) study in the San Francisco Bay Area, California in 2016-2017. Data from 84 young adult smokers (44% identified as sexual minority, including 29 bisexual and 8 gay/lesbian) with 6498 EMA assessments were analyzed. Both internal and external predictors and interaction terms between each predictor and sexual group were examined using generalized estimating equation models.nnnRESULTSnCommon correlates of smoking were found for both groups (e.g., craving, absence of smoking bans, presence of other smokers, outside location, and seeing triggers). Unique factors for sexual minority smokers were being at a bar (aORu2009=u20091.75, 95% CIu2009=u20091.06-2.90) and the number of other smokers present (aORu2009=u20091.12, 95%CIu2009=u20091.04-1.20), while the presence of a smoking family member reduced the odds of smoking in this group (aORu2009=u20090.13, 95%CIu2009=u20090.02-0.85). In interaction models, the number of other smokers exerted a greater influence on sexual minority participants compared to their heterosexual counterparts (aORu2009=u20091.10, 95%CIu2009=u20091.01-1.20), while craving (aORu2009=u20090.84, 95%CIu2009=u20090.75-0.93) and presence of a smoking family member (aORu2009=u20090.11, 95%CIu2009=u20090.01-0.82) had weaker influences.nnnCONCLUSIONSnOur study highlights unique situational factors associated with smoking among sexual minority young adults and differences in these factors by sexual identity. Future interventions targeting sexual minorities should address bar attendance and specific triggers.

Collecting outcome data of a text messaging smoking cessation intervention with in-program text assessments: How reliable are the results?

BACKGROUNDnText messaging interventions have shown promise in helping people quit smoking. Texting programs periodically survey participants about their smoking status. This study examined the consistency of participant self-reported smoking between external surveys and internal program text message assessments.nnnMETHODSnParticipants in Text2Quit program were surveyed about their past 7-day smoking at one, three, and six months post-enrollment using different survey modes (external surveys and internal program text message assessments) and responses were compared for consistency. The first set of analyses was conducted for participants responding on both modes (nu202f=u202f45 at one month; nu202f=u202f50 at three months; nu202f=u202f42 at six months). Additional analyses, assuming missingu202f=u202fsmoking, were conducted with the full sample of 262 smokers (68.7% female, mean ageu202f=u202f35.8u202fyears) and compared to saliva-confirmed abstinence rates.nnnRESULTSnParticipants responding to both modes consistently reported smoking status at one (88.9%), three (88.0%) and six (88.1%) months post-enrollment, with fair to substantial levels of agreement (one month: κu202f=u202f0.24; three months: κu202f=u202f0.63; six months: κu202f=u202f0.66). Participants responding to both modes reported high rates of abstinence. In missingu202f=u202fsmoking analyses, significant differences in abstinence rates reported across modes were detected at each timepoint (one month: externalu202f=u202f30.5%, internalu202f=u202f16.4%; three months: externalu202f=u202f33.2%, internalu202f=u202f16.0%; six months: externalu202f=u202f31.7%, internalu202f=u202f12.2%; all pu202f<u202f.001). Moderate levels of agreement were found between the two modes. At 6u202fmonths, abstinence rates obtained via internal data were closer to those biochemically verified (15.7%) compared to external surveys.nnnCONCLUSIONSnResults provide initial support for the use of internal program assessments in text messaging programs with missingu202f=u202fsmoking assumptions in order to gather outcome data on smoking behavior.