Kathleen R. Case

E-cigarette use among Texas youth: Results from the 2014 Texas Youth Tobacco Survey

INTRODUCTION Several characteristics of electronic cigarettes (e-cigarettes), such as candy flavorings, are worrisome for attracting youth. The current cross-sectional study uses data on e-cigarette use from the 2014 Texas Youth Tobacco Survey (TYTS), a representative statewide sample of Texas middle school and high school students. This studys aims are to determine the prevalence of e-cigarette use, including rates of concurrent use with other tobacco products among Texas youth and to describe the demographic and tobacco use differences between e-cigarette users and non-users. METHODS Participants were 13,602 6th through 12th grade students in Texas. Descriptive statistics were generated to determine the prevalence of current and lifetime e-cigarette use and to determine the prevalence of demographic characteristics across e-cigarette usage groups. Logistic regression analyses were conducted to examine differences in demographic characteristics, cigarette use in the home, and tobacco use behaviors for e-cigarette users versus non-users. RESULTS Almost one quarter of all middle and high school students reported lifetime e-cigarette use and 14.0% were past 30-day users of these products. Current e-cigarette users were more likely to be high school students, white and male than non-current users. Both current and lifetime e-cigarette users were also more likely than their peers to use other tobacco products, although 24.2% of current e-cigarette users had never smoked conventional cigarettes, and 7.3% had never used any other type of tobacco product besides an e-cigarette. CONCLUSIONS Findings highlight the urgency to regulate e-cigarettes as well as to include these products in tobacco prevention programs.

Formative research to identify perceptions of e-cigarettes in college students: Implications for future health communication campaigns.

ABSTRACT Objective: This formative study examined perceptions of e-cigarettes in college students with the goal of informing future health communication campaigns. Differences between e-cigarette users and nonusers were also examined. Participants: Thirty undergraduate students were recruited from a large southwestern public university (15 users, 15 nonusers). Methods: Structured interviews were conducted and transcripts were coded for themes. Results: Although users had more favorable attitudes toward e-cigarettes, both users and nonusers believed that e-cigarettes produce water vapor and reported that e-cigarettes were less harmful than conventional cigarettes. Potential health consequences and addiction concerns were the most common perceived threats for both users and nonusers. Both nonusers and users cited social stigma as a perceived disadvantage of e-cigarette use. Conclusions: Ultimately, themes with particular relevance to future health communication campaigns included negative perceptions of e-cigarette users and social stigma, as well as harm perceptions and potential health consequences associated with e-cigarette use.

The association between sensation seeking and e-cigarette use in Texas young adults: A cross-sectional study

ABSTRACT Objective: To examine the associations between sensation seeking and ever and current e-cigarette use in Texas young adults (18–29 years old). Current cigarette use was examined as a potential effect modifier of the associations. Participants: Participants included college students enrolled in four-year and two-year colleges in four metropolitan areas in Texas (n = 5,418) who completed the survey between November 2014 and February 2015. Methods: This cross-sectional study utilized mixed effects logistic regression to determine the associations between mean sensation seeking scores and ever and current e-cigarette use after controlling for covariates. Results: After controlling for covariates, significant associations between sensation seeking and both ever and current e-cigarette use were observed; however, these associations were significant for noncurrent smokers only (adjusted odds rations [AOR] = 1.55, 95% confidence interval (CI) = 1.39, 1.73; AOR = 1.82, 95% CI = 1.54, 2.15, respectively). Conclusions: Sensation seeking is an important factor in identifying college students who may be at increased risk for e-cigarette use behaviors.

The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents

INTRODUCTION Sensation seeking is strongly associated with cigarette use in adolescents. However, few studies have investigated its relationship with adolescent e-cigarette use. This study examined cross-sectional and longitudinal associations between sensation seeking and a variety of e-cigarette use behaviors among Texas adolescents. METHODS This study utilized two waves of data collected 6months apart through the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in 2014-2015 (n=2,488/N=461,069). TATAMS employs a complex probability-sampling design and is representative of students in 6th, 8th and 10th grades from five counties surrounding the four largest cities in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Weighted multivariable logistic regression was used to examine the cross-sectional and longitudinal associations between sensation seeking and susceptibility to e-cigarette use, ever e-cigarette use, and current (past 30day) e-cigarette use. RESULTS In the cross-sectional analyses, higher mean sensation seeking scores were associated with higher odds of both susceptibility to e-cigarette use and ever e-cigarette use (AOR=1.25, 95% CI=1.07, 1.47; AOR=1.24, 95% CI=1.08, 1.43, respectively). For the longitudinal analyses, only the association between higher mean sensation seeking scores and transition to ever e-cigarette use remained statistically significant (AOR=1.45, 95% CI=1.01, 2.08). There were no significant associations between sensation seeking and current e-cigarette use in either the cross-sectional or longitudinal analyses. CONCLUSIONS Higher sensation seeking scores were consistently and significantly related to experimentation with e-cigarette use among Texas adolescents. Future interventions (e.g., communication campaigns) should target high sensation seeking adolescents to reduce initiation of e-cigarette use among this population.

Bullied Status and Physical Activity in Texas Adolescents

This study examined the association between having been bullied at school during the past 6 months (“bullied status”) and not meeting physical activity (PA) recommendations of 60 minutes of daily PA during the past week among 8th- and 11th-grade Texas adolescents. Multiple logistic regression analysis was conducted to examine this association, adjusted for weight status, grade, race/ethnicity, and stratified by gender; furthermore, a significant interaction was found between bullied status and weight status. Results are presented by interaction status. Results indicated that overweight girls who reported never being bullied, as well as those who reported being bullied more than twice, had higher odds of not meeting PA recommendations than normal weight girls who were never bullied (adjusted odds ratio [AOR] = 2.12, 95% confidence interval [CI: 1.12, 3.99]; AOR = 9.18, 95% CI [2.26, 37.27], respectively). Obese girls who were bullied once or twice had higher odds of not meeting PA recommendations than normal weight girls who were never bullied (AOR = 2.89, 95% CI [1.06, 7.89]). Overweight boys who reported never being bullied had lower odds of not meeting PA recommendations than normal weight boys who were never bullied (AOR = 0.62, 95% CI [0.39, 0.97]). Conversely, obese boys who were bullied once or twice reported higher odds of not meeting PA recommendations than normal weight boys who were never bullied (AOR = 3.61, 95% CI [1.22, 10.67]). Findings from this study indicate that the association between bullied status and meeting PA recommendations is complex and may differ by gender and the interaction between bullied status and weight status.

Positive Outcome Expectations and Tobacco Product Use Behaviors in Youth

ABSTRACT Background: Outcome expectations are an important determinant of health behavior, according to Social Cognitive Theory; yet recent literature has not examined the relationship between outcome expectations and tobacco product use (e.g., use of cigarettes, cigars, hookah, e-cigarettes, or smokeless tobacco). Objectives: This study examines if outcome expectations at baseline, among an adolescent cohort of never users of tobacco products, predicts tobacco product use (i.e., cigarettes, hookah, e-cigarette, cigar, or smokeless tobacco) or susceptibility to use at 6-month follow-up. Methods: Data are from the first two waves of a Texas cohort study of urban middle school and high school students, which were collected in 2014–2015. Logistic regression analyses were used; these adjusted for socio-demographic variables. Analyses were limited to never users of any tobacco product at baseline (n = 1999, N = 357,035). Results: Outcome expectations related to stress relief predicted ever use of (AOR: 4.21, 95% CI 1.84–9.60) and susceptibility (AOR: 2.97, 95% CI 1.01–8.70) to tobacco products. Additional outcome expectations (e.g., relaxation, concentration, slimness, etc.) were not associated with ever use or susceptibility. Conclusions/Importance: This study extends the literature regarding outcome expectations among adolescents regarding tobacco products. It is important that interventions offer alternative solutions to stress relief that do not include tobacco products.

Source Credibility and E-Cigarette Attitudes: Implications for Tobacco Communication

ABSTRACT As there are many conflicting sources of e-cigarette information, research is needed to determine the impact of these sources on e-cigarette attitudes to inform future communication campaigns. Source credibility is important in shaping attitudes toward other health topics; however, no study has examined its role in influencing e-cigarette attitudes. Data from the 2015 Health Information National Trends Survey-FDA (HINTS-FDA) were utilized to assess differences in trust in different sources by e-cigarette user status and to investigate the associations between trust in sources and e-cigarette attitudes (n = 3,738). Differences in trust in sources were examined using weighted linear regression. Associations between trust in sources of e-cigarette health effects and attitudes toward e-cigarettes were assessed using weighted logistic regression. Overall, e-cigarette ever users reported significantly lower trust in governmental agencies as compared to never users. Trust in e-cigarette companies was negatively associated with perceived addictiveness of e-cigarettes (AOR = 0.76, 95% CI = 0.58, 1.00), while trust in doctors/pharmacists/healthcare providers was negatively associated with harm perceptions of e-cigarettes relative to conventional cigarettes (AOR = 0.72, 95% CI = 0.55, 0.95). Trust in tobacco companies and trust in e-cigarette companies were negatively associated with absolute perceived harm of e-cigarettes (AOR = 0.70, 95% CI = 0.51, 0.95; AOR = 0.60, 95% CI = 0.46, 0.79, respectively). Results from this study indicate that the associations between trust in sources of e-cigarette health effects and e-cigarette attitudes differ both by source and specific attitude assessed. Ultimately, future campaigns should incorporate messaging to discredit industry sources of information and utilize non-governmental sources to effectively influence e-cigarette attitudes.

A longitudinal study of risk perceptions and e-cigarette initiation among college students: Interactions with smoking status

BACKGROUND Recent data suggest that lower perceived risks of e-cigarettes are associated with e-cigarette use in young adults; however, the temporality of this relationship is not well-understood. We explore how perceptions of harmfulness and addictiveness of e-cigarettes influence e-cigarette initiation, and specifically whether this association varies by cigarette smoking status, in a longitudinal study of tobacco use on college campuses. METHODS Data are from a 5-wave 24-college study in Texas. Only students who reported never using e-cigarettes at wave 1 were included (n = 2565). Multilevel discrete-time hazard models, accounting for school clustering, were used. The dependent variable, ever e-cigarette use, was assessed at each wave. Both time-varying (e-cigarette perceptions of harmfulness and addictiveness, age, use of cigarettes, use of other tobacco products, and use of other substances) and time-invariant demographic covariates were included. Two-way interactions between each e-cigarette perception variable and current conventional cigarette use were tested to determine if the hypothesized relationship differed among smokers and non-smokers. RESULTS 21% of all never e-cigarette users at baseline had initiated e-cigarette ever use by wave 5. Significant two-way interactions qualified the relationship between risk perceptions and e-cigarette initiation. Specifically, perceptions of a lower degree of harmfulness (OR = 1.13, p = .047) and addictiveness (OR = 1.34, p < .001) of e-cigarettes predicted initiation among non-smokers, but not among current smokers. CONCLUSION Perceiving a lower degree of risk of e-cigarettes contributes to subsequent e-cigarette initiation among non-smokers, but not among current smokers. FINDINGS have implications for prevention campaigns focusing on the potential harm of e-cigarettes for non-smoking college students.

Victims of Bullying and Tobacco Use Behaviors in Adolescents: Differences between Bullied at School, Electronically, or Both.

BACKGROUND Being a victim of bullying is associated with greater risk of youth substance use; however, research specifically examining whether tobacco use behaviors differ among adolescents who were bullied at school only, electronically only, or both at school and electronically is limited. METHODS We examined the associations between being a victim of bullying (at school only, electronically only, or both at school and electronically) and use of tobacco products using data from the 2013 national Youth Risk Behavior Survey. RESULTS Girls who were bullied both at school and electronically reported the highest odds of all tobacco use behaviors (ever use of cigarettes, current use of cigarettes, and current use of any tobacco product) as compared with girls who were not bullied after adjusting for covariates. Conversely, for boys, only the association between being bullied electronically only and ever use of cigarettes remained significant after adjusting for covariates. CONCLUSIONS Results from this study indicate that electronic bullying may differentially influence the odds of tobacco use in high school students as compared with bullying that occurs at school only. Confirmation of these findings could inform interventions to reduce both bullying and tobacco use in high school.

School socioeconomic disparities in e-cigarette susceptibility and use among central Texas middle school students.

Social-ecological theory posits that health-related behavior is shaped by the environments and settings that surround us. We examined e-cigarette susceptibility and ever use prevalence among central Texas middle school students by the level of economic disadvantage (ED) of their school. As a secondary aim, we explored gender and ethnic differences (Hispanic vs. White) in e-cigarette susceptibility across school ED levels. A cross-sectional analysis was conducted of baseline data collected in 2017 as part of the CATCH My Breath study. Participants (n = 5278) were 6th grade students from 23 central Texas public middle schools. E-cigarette susceptibility/use and demographics were self-reported; school ED was determined by Texas Education Agency. Analyses included chi-square tests and multi-level logistic regression. E-cigarette susceptibility and use varied by school ED for total sample (p < .0001) and by ethnicity (p ≤ .003). While e-cigarette susceptibility was higher in boys (p < .001), no gender differences were found for e-cigarette use. Students in the highest school ED quartile (Q4) (lowest SES) had significantly higher odds of e-cigarette susceptibility (AOR = 2.01; 95% CI: 1.49–2.71) and use (AOR = 8.12, 95% CI: 2.58–26.30) compared with Q1 students. Significant gender differences in e-cigarette susceptibility persisted within school ED quartiles 1–3 (p ≤ .001); no gender differences were found for Q4 (p = .537). Despite overall higher e-cigarette susceptibility for Hispanic students, they had similar prevalence as White students within three school ED quartiles. Findings underscore a higher risk for e-cigarette susceptibility/use among central Texas sixth graders attending high ED schools and provide foundation for further exploration of the school socioeconomic context in adolescent e-cigarette use.