Youn Ok Lee

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.

Multiple tobacco product use among adults in the United States: Cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus

OBJECTIVE Noncigarette tobacco products are increasingly popular. Researchers need to understand multiple tobacco product use to assess the effects of these products on population health. We estimate national prevalence and examine risk factors for multiple product use. METHOD We calculated prevalence estimates of current use patterns involving cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus using data from the 2012 RTI National Adult Tobacco Survey (N=3627), a random-digit-dial telephone survey of adults aged 18 and over. Associations between use patterns (exclusive single product and multiple products) and demographic characteristics were examined using Pearson chi-square tests and logistic regression. RESULTS 32.1% of adults currently use 1 or more tobacco products; 14.9% use cigarettes exclusively, and 6.6% use one noncigarette product exclusively, 6.9% use cigarettes with another product (dual use), 1.3% use two noncigarette products, and 2.4% use three or more products (polytobacco use). Smokers who are young adult, male, never married, reside in the West, and made prior quit attempts were at risk for multiple product use. CONCLUSIONS Over 10% of U.S. adults use multiple tobacco products. A better understanding of multiple product use involving combustible products, like cigars and hookah, is needed. Multiple product use may be associated with past quit attempts.

Youth Tobacco Product Use in the United States

BACKGROUND: Noncigarette tobacco products are increasingly popular among youth, especially cigarette smokers. Understanding multiple tobacco product use is necessary to assess the effects of tobacco products on population health. This study examines multiple tobacco product use and associated risk factors among US youth. METHODS: Estimates of current use were calculated for cigarettes, cigars, smokeless tobacco, hookah, e-cigarettes, pipes, bidis, kreteks, snus, and dissolvable tobacco by using data from the 2012 National Youth Tobacco Survey (n = 24 658), a nationally representative sample of US middle and high school students. Associations between use patterns and demographic characteristics were examined by using multinomial logistic regression. RESULTS: Among youth, 14.7% currently use 1 or more tobacco products. Of these, 2.8% use cigarettes exclusively, and 4% use 1 noncigarette product exclusively; 2.7% use cigarettes with another product (dual use), and 4.3% use 3 or more products (polytobacco use). Twice as many youth use e-cigarettes alone than dual use with cigarettes. Among smokers, polytobacco use was significantly associated with male gender (adjusted relative risk ratio [aRRR] = 3.71), by using flavored products (aRRR = 6.09), nicotine dependence (aRRR = 1.91), tobacco marketing receptivity (aRRR = 2.52), and perceived prevalence of peer use of tobacco products (aRRR = 3.61, 5.73). CONCLUSIONS: More than twice as many youth in the United States currently use 2 or more tobacco products than cigarettes alone. Continued monitoring of tobacco use patterns is warranted, especially for e-cigarettes. Youth rates of multiple product use involving combustible products underscore needs for research assessing potential harms associated with these patterns.

Adult smokers’ receptivity to a television advert for electronic nicotine delivery systems

Objective The aim of the present work was to examine adult smokers’ awareness of and receptivity to an electronic nicotine delivery system (ENDS) television advert, and whether viewing the advert influenced urge to smoke and intention to try ENDS. Methods A television advert for ENDS brand blu eCigs was shown to an online convenience sample of 519 Florida adult smokers. We measured current smokers’ awareness of and receptivity to the advert, and whether seeing the advert influenced their thoughts about smoking or quitting, urge to smoke and intention to try ENDS. Results were stratified by prior ENDS use. Results Approximately 62.3% of current smokers were aware of the advert. Smokers found the advert informative (73.8%), attention grabbing (67.5%) and innovative (64.5%), with prior ENDS users rating the advert more favourably than non-users. Seeing the advert elicited an urge to smoke (mean 42.1, SD=1.9) and thoughts about smoking cigarettes (75.8%) as well as quitting (74.6%). Prior END users were significantly more likely than non-users to report thinking about smoking cigarettes after seeing the advert (P<0.05). Most smokers said ENDS were ‘made for people like them’ (88.6%) and they would try ENDS in the future (66.0%). Conclusions Smokers are receptive to ENDS television adverts and report intention to try ENDS after viewing the advert. Future studies should monitor ENDS advertising and examine how exposure to ENDS adverts influences smokers’ use of ENDS, dual use with cigarettes and cessation behaviour.

‘Vape shops’ and ‘E-Cigarette lounges’ open across the USA to promote ENDS

Electronic nicotine delivery systems (ENDS), commonly called electronic cigarettes or e-cigarettes, first became available in the USA in 2007.1 Since then, US ENDS sales are reported in the press to have doubled annually to reach US

Smoking characteristics among lesbian, gay, and bisexual adults:

1 billion for January–August 2013.2 ENDS sales are estimated by one news source to reach US

Understanding Tobacco-Related Attitudes Among College and Noncollege Young Adult Hookah and Cigarette Users

4 billion globally by the end of 2013.3 From 2010 to 2011, awareness of ENDS among US adults increased from 40.9% to 57.9% and ever use increased from 3.3% to 6.2%.4 ENDS organisations have formed an industry that has begun advocating for its interests by promoting ENDS products and favourable policies for ENDS manufacturers and retailers.5 ENDS were initially promoted and sold online, but have quickly expanded to traditional brick and mortar retail outlets, like grocery stores and gas stations. Independent retail specialty shops that exclusively sell ENDS products, or ‘vape shops’, are opening around the USA and abroad,3 with over 3500 such shops estimated in the USA6 (figure 1). Vape shops sell ENDS products found in traditional retail stores (eg, starter kits, cartridges and disposable ENDS) but can offer a substantially …

Using Peer Crowds to Segment Black Youth for Smoking Intervention

OBJECTIVE Cigarette smoking is the leading preventable cause of death and disease in the United States. Sexual minorities (lesbians, gay men, and bisexuals), smoke at higher rates than the general population. However, little else is known about sexual minority smokers. Furthermore, the sexual minority population is diverse and little research exists to determine whether subgroups, such as lesbians, gay men, and female and male bisexuals, differ on smoker characteristics. We examine differences in smoking characteristics (advertising receptivity, age of first cigarette, non-daily smoking, cigarettes per day, nicotine dependence, desire to quit and past quit attempts) among lesbians, gay men, and female and male bisexual adults in the United States. METHODS Secondary analysis of the CDCs (Centers for Disease Control and Prevention) 2009-2010 National Adult Tobacco Survey (N=118,590). RESULTS Controlling for age, race, socioeconomic status and geographic region, identifying as a female bisexual was associated with fewer past quit attempts, lower age at first cigarette, and higher nicotine dependence when compared to heterosexual women. There were no differences in desire to quit between male or female sexual minorities and their heterosexual counterparts. CONCLUSION Sexual minority individuals smoke at higher rates than heterosexuals and yet similarly desire to quit. Tailored efforts may be needed to address smoking among bisexual women.

Research support for effective state and community tobacco control programme response to electronic nicotine delivery systems

Abstract Objective: To examine differences in tobacco-related attitudes and hookah and cigarette use among college and noncollege young adults. Participants: Time-location samples of young adult bar patrons in San Diego, California (N = 2,243), Tulsa (N = 2,095) and Oklahoma City (N = 2,200), Oklahoma, Albuquerque (N = 1,044) and Las Cruces (N = 894), New Mexico, between September 2009 and July 2011. Methods: Multinomial logistic regression examined associations between hookah and cigarette use and tobacco-related attitudes. Results: Current college students and graduates are less likely to smoke cigarettes, but more likely to use hookah. Among current hookah users, 22.6% were hookah-only users and 77.4% were dual users (cigarettes and hookah). College status is associated with different hookah use patterns, and those with anti-tobacco industry attitudes were more likely to smoke hookah. Conclusions: Novel interventions are needed for college students using hookah. Existing strategies targeting smokers with anti-tobacco industry messages may be irrelevant to hookah users.

Young adult social smokers: Their co-use of tobacco and alcohol, tobacco-related attitudes, and quitting efforts

Studies of peer crowds show promise for enhancing public health promotion and practice through targeting. Distinct images, role models, and social norms likely influence health behaviors of different peer crowds within health disparity groups. We describe peer crowds identified by Black young people and determine whether identification with them is associated with smoking. Data from Black young people aged 13 to 20 years in Richmond, Virginia, were collected via interview and online survey (N = 583). We identified the number and type of peer crowds using principal components analysis; associations with smoking were analyzed using Pearson chi-square tests and logistic regression. Three peer crowds were identified—“preppy,” “mainstream,” and “hip hop.” Youth who identify with the hip hop peer crowd were more likely to smoke and have friends who smoke and less likely to hold antitobacco attitudes than those identifying with preppy or mainstream crowds. Identifying with the hip hop crowd significantly increased the odds of smoking, controlling for demographic factors (odds ratio = 1.97; 95% confidence interval = 1.03-3.76). Tobacco prevention efforts for Black youth and young adults should prioritize the hip hop crowd. Crowd identity measures can aid in targeting public health campaigns to effectively engage those at highest risk.