Lauren Porter

Exposure to Electronic Cigarette Television Advertisements Among Youth and Young Adults

BACKGROUND AND OBJECTIVE: Currently, the US Food and Drug Administration does not regulate electronic cigarette (e-cigarette) marketing unless it is advertised as a smoking cessation aid. To date, the extent to which youth and young adults are exposed to e-cigarette television advertisements is unknown. The objective of this study was to analyze trends in youth and young adult exposure to e-cigarette television advertisements in the United States. METHODS: Nielsen data on television household audiences’ exposure to e-cigarette advertising across US markets were examined by calendar quarter, year, and sponsor. RESULTS: Youth exposure to television e-cigarette advertisements, measured by target rating points, increased 256% from 2011 to 2013. Young adult exposure increased 321% over the same period. More than 76% of all youth e-cigarette advertising exposure occurred on cable networks and was driven primarily by an advertising campaign for 1 e-cigarette brand. CONCLUSIONS: E-cigarette companies currently advertise their products to a broad audience that includes 24 million youth. The dramatic increase in youth and young adult television exposure between 2011 and 2013 was driven primarily by a large advertising campaign on national cable networks. In the absence of evidence-based public health messaging, the current e-cigarette television advertising may be promoting beliefs and behaviors that pose harm to the public health. If current trends in e-cigarette television advertising continue, awareness and use of e-cigarettes are likely to increase among youth and young adults.

Adolescent Electronic Cigarette Use: Associations With Conventional Cigarette and Hookah Smoking.

INTRODUCTION The emerging trends and rapid growth of electronic cigarettes (e-cigarettes) among adolescents are being monitored closely. The trends are critical as policy to prevent uptake among adolescents is considered. The purpose of this study is to describe the prevalence of e-cigarette use and potential correlates for use. Associations between e-cigarettes, cigarettes, and hookah are assessed. METHODS This study used data from the 2013 Florida Youth Tobacco Survey. Prevalence estimates were calculated in 2014 and differences were determined based on CIs. Adjusted logistic regression models were used to identify correlates of e-cigarette use among participants based on demographic and other tobacco products used. RESULTS There were no sex differences in middle school, whereas male high school students reported higher use than their female counterparts. Cigarette smoking and hookah use were significantly associated with ever and current e-cigarette use among both middle and high school students. CONCLUSIONS Although e-cigarettes are being assessed as a potential replacement product for traditional tobacco, evidence from this study indicates the possibility of multiple product use among adolescents. E-cigarettes are not only associated with traditional cigarettes, but also with hookahs, a similar emerging product that offer tobacco flavors that may appeal to adolescents. Notably, many e-cigarette users also reported no cigarette or hookah use.

Using Twitter Data to Gain Insights into E-cigarette Marketing and Locations of Use: An Infoveillance Study

Background Marketing and use of electronic cigarettes (e-cigarettes) and other electronic nicotine delivery devices have increased exponentially in recent years fueled, in part, by marketing and word-of-mouth communications via social media platforms, such as Twitter. Objective This study examines Twitter posts about e-cigarettes between 2008 and 2013 to gain insights into (1) marketing trends for selling and promoting e-cigarettes and (2) locations where people use e-cigarettes. Methods We used keywords to gather tweets about e-cigarettes between July 1, 2008 and February 28, 2013. A randomly selected subset of tweets was manually coded as advertising (eg, marketing, advertising, sales, promotion) or nonadvertising (eg, individual users, consumers), and classification algorithms were trained to code the remaining data into these 2 categories. A combination of manual coding and natural language processing methods was used to indicate locations where people used e-cigarettes. Additional metadata were used to generate insights about users who tweeted most frequently about e-cigarettes. Results We identified approximately 1.7 million tweets about e-cigarettes between 2008 and 2013, with the majority of these tweets being advertising (93.43%, 1,559,508/1,669,123). Tweets about e-cigarettes increased more than tenfold between 2009 and 2010, suggesting a rapid increase in the popularity of e-cigarettes and marketing efforts. The Twitter handles tweeting most frequently about e-cigarettes were a mixture of e-cigarette brands, affiliate marketers, and resellers of e-cigarette products. Of the 471 e-cigarette tweets mentioning a specific place, most mentioned e-cigarette use in class (39.1%, 184/471) followed by home/room/bed (12.5%, 59/471), school (12.1%, 57/471), in public (8.7%, 41/471), the bathroom (5.7%, 27/471), and at work (4.5%, 21/471). Conclusions Twitter is being used to promote e-cigarettes by different types of entities and the online marketplace is more diverse than offline product offerings and advertising strategies. E-cigarettes are also being used in public places, such as schools, underscoring the need for education and enforcement of policies banning e-cigarette use in public places. Twitter data can provide new insights on e-cigarettes to help inform future research, regulations, surveillance, and enforcement efforts.

A Multiyear Assessment of Hookah Use Prevalence Among Florida High School Students

INTRODUCTION The purpose of this study was to assess the prevalence of hookah use among Florida high school students over time. Alternative tobacco products, including hookah, pose a public health threat to tobacco prevention efforts, especially among adolescents. METHODS Florida Youth Tobacco Survey data, representing all public high school students in the state, were analyzed to assess the prevalence of lifetime and current hookah use and were compared by demographic groups. Multiple years of data (2007-2012) were examined to assess changes over time. RESULTS During the past 6 years, there was an increase in lifetime hookah use among Florida high school students. While males remained at a higher rate overall, female adolescents increased at a faster rate. Hispanic and non-Hispanic White respondents reported increased trends as well. Current use trends did not change over 4 years, remaining at about 8%. CONCLUSIONS Hookah is a new tobacco product in the United States that appears attractive to youth, with dramatic increases among the state population. While cigarette use among youth is declining in Florida, the increasing uptake of alternative tobacco products may lessen the overall public health gains for tobacco use. There is a need for continued monitoring of hookah use among the adolescent population, for both prevention and cessation efforts as well as policy interventions to address this emerging trend.

Electronic Cigarette and Traditional Cigarette Use among Middle and High School Students in Florida, 2011-2014.

Recent youth trends in the prevalence of e-cigarette and traditional cigarette use in Florida were examined in a cross-sectional, representative state sample from 2011 to 2014. Traditional cigarette use among youth declined during the study period. Experimentation with and past 30-day use of e-cigarettes among Florida youth tripled over 4 years. Past 30-day e-cigarette use exceeded traditional cigarette use in 2014; 10.8% of high school and 4.0% of middle school students reported recent e-cigarette use, compared with 8.7% of high school and 2.9% of middle school students for traditional cigarettes (P<0.001). By 2014, 20.5% of high school and 8.5% of middle school students reported ever use of e-cigarettes. Among ever e-cigarette users in 2014, 30.3% of high school and 42.2% of middle school students had never smoked traditional cigarettes. Given the concern that significant rates of e-cigarette use by U.S. adolescents may have a negative effect on public health, further review of e-cigarette advertising, marketing, sales, and use among U.S. youth is warranted.

Identifying e-cigarette vape stores: description of an online search methodology

Background Although the overall impact of Electronic Nicotine Delivery Systems (ENDS) on public health is unclear, awareness, use, and marketing of the products have increased markedly in recent years. Identifying the increasing number of ‘vape stores’ that specialise in selling ENDS can be challenging given the lack of regulatory policies and licensing. This study assesses the utility of online search methods in identifying ENDS vape stores. Methods We conducted online searches in Google Maps, Yelp, and YellowPages to identify listings of ENDS vape stores in Florida, and used a crowdsourcing platform to call and verify stores that primarily sold ENDS to consumers. We compared store listings generated from the online search and crowdsourcing methodology to list licensed tobacco and ENDS retailers from the Florida Department of Business and Professional Regulation. Results The combined results from all three online sources yielded a total of 403 ENDS vape stores. Nearly 32.5% of these stores were on the state tobacco licensure list, while 67.5% were not. Accuracy of online results was highest for Yelp (77.6%), followed by YellowPages (77.1%) and Google (53.0%). Conclusions Using the online search methodology we identified more ENDS vape stores than were on the state tobacco licensure list. This approach may be a promising strategy to identify and track the growth of ENDS vape stores over time, especially in states without a systematic licensing requirement for such stores.

The Impact of a State-Sponsored Mass Media Campaign on Use of Telephone Quitline and Web-Based Cessation Services

Introduction Most US smokers do not use evidence-based interventions as part of their quit attempts. Quitlines and Web-based treatments may contribute to reductions in population-level tobacco use if successfully promoted. Currently, few states implement sustained media campaigns to promote services and increase adult smoking cessation. This study examines the effects of Florida’s tobacco cessation media campaign and a nationally funded media campaign on telephone quitline and Web-based registrations for cessation services from November 2010 through September 2013. Methods We conducted multivariable analyses of weekly media-market–level target rating points (TRPs) and weekly registrations for cessation services through the Florida Quitline (1-877-U-CAN-NOW) or its Web-based cessation service, Web Coach (www.quitnow.net/florida). Results During 35 months, 141,221 tobacco users registered for cessation services through the Florida Quitline, and 53,513 registered through Web Coach. An increase in 100 weekly TRPs was associated with an increase of 7 weekly Florida Quitline registrants (β = 6.8, P < .001) and 2 Web Coach registrants (β = 1.7, P = .003) in an average media market. An increase in TRPs affected registrants from multiple demographic subgroups similarly. When state and national media campaigns aired simultaneously, approximately one-fifth of Florida’s Quitline registrants came from the nationally advertised portal (1-800-QUIT-NOW). Conclusion Sustained, state-sponsored media can increase the number of registrants to telephone quitlines and Web-based cessation services. Federally funded media campaigns can further increase the reach of state-sponsored cessation services.

The effect of survey nonresponse on quitline abstinence rates: Implications for practice

INTRODUCTION Quitline outcome studies are used to maintain and improve the effectiveness of these evidence-based cessation services. Nonresponse has the potential to bias survey results and many US and Canadian quitlines are reporting survey response rates below 50%. This study examines the effect of nonresponse bias on quit rates in three state quitline populations. Results provide implications of nonresponse bias for quitline practice. METHODS Quit status, defined as abstinent for 30 days or more 7 months after registering for services, was collected from Minnesota, Hawaii, and Florida quitline participants that responded to a survey. We assigned each responder to a wave based on the number of contacts required to obtain a survey response. RESULTS The latest two responder groups had the lowest quit rates within each state, although results were not statistically significant. Quit rates in the latest responder wave (Wave 6) were between 4% and 13% points lower than the earliest responders (Wave 1). The cumulative quit rates show what the quit rate would have been had the study ended after the corresponding wave. In all four studies, the cumulative quit rate was lowest in Wave 6. CONCLUSION To increase accuracy of quit rates, quitlines should focus on increasing survey response rates. Suggestions for improving survey response rates are provided.

Using Web Panels to Understand Whether Online Ad Exposure Influences Information-Seeking Behavior:

Measuring the impact of online health campaigns is challenging. Traditionally, advertisement click-through rates (CTRs) have been used to measure message reach, but CTRs are low with most clicks coming from a small fraction of users. However, low CTRs do not necessarily indicate that an ad was not effective. There may be latency effects whereby people do not click on ads at time of exposure but visit the promoted website or conduct searches later. Online panels that unobtrusively collect panelists’ web behavior may provide a more reliable data source for measuring online campaign effects. We used web behavior data from a proprietary online panel to identify panelists who were either exposed or unexposed to the Tobacco Free Florida Cessation Internet ad campaign. We assessed whether ad exposure influenced website visits and searches on campaign-related topics up to 4 weeks after initial exposure. Those who were exposed to the campaign were significantly more likely than those who were not exposed to have visited the campaign website (0.65% vs. 0.13%, respectively, p < .001), but ad exposure did not influence searches on campaign-related topics. These results suggest that panel web behavior data may be useful for understanding behavioral response to and latency effects of online campaigns.

Prevalence and characteristics of secondhand smoke and secondhand vapour exposure among youth

Background It is well established that secondhand smoke (SHS) is harmful, and concern about the potential dangers associated with secondhand vapour (SHV) (ie, vapour from electronic vapour products, EVP) is growing. The present study examines the prevalence and characteristics associated with SHS and SHV exposure. Methods Data from youth aged 11–17 who completed the 2016 Florida Youth Tobacco Survey (n=58 616) were analysed. Demographics, past 30 day SHS and SHV exposure, environmental factors, cigarette and EVP use status, SHS and SHV harm perceptions, and tobacco susceptibility were assessed. Weighted multivariable logistic regressions were performed to examine characteristics associated with SHS and SHV exposure, and SHS and SHV exposure with tobacco susceptibility. Results Overall, 42% of Florida youth reported SHS exposure and 29% reported SHV exposure during the past 30 days. Living in a home where tobacco use was permitted (vs not permitted) was positively associated with SHS (adjusted OR (AOR) 2.57) and SHV exposure (AOR 1.56). Perceived SHS as harmful (vs not harmful) was positively associated with SHS (AOR 1.73) and SHV exposure (AOR 1.97), while perceived SHV as harmful was negatively associated with SHS (AOR 0.86) and SHV exposure (AOR 0.56). SHS and SHV exposure was significantly associated with susceptibility to cigarette and EVP use (AOR 1.40 and 2.08, respectively). Conclusions Almost one-third of Florida youth reported SHV exposure. Factors associated with SHS and SHV exposure are somewhat similar, and exposure to SHS and SHV is associated with tobacco susceptibility in youth. Promoting tobacco-free homes is needed to protect youth from SHS and SHV exposure.