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The vaping controversy
\"This work provides an evenhanded and authoritative overview of vaping and its impact on American culture and public health, especially among younger Americans\"-- Provided by publisher.
Book
E-cigarette Advertising Exposure, Explicit and Implicit Harm Perceptions, and E-cigarette Use Susceptibility Among Nonsmoking Young Adults
This study tested whether exposure to e-cigarette advertising increases e-cigarette use susceptibility among nonsmoking young adults by promoting explicit and implicit attitudes toward e-cigarettes as a safer and healthier alternative to combustible cigarettes.
Young adult current nonsmokers who had never used an e-cigarette (n = 393; mean age = 22.1, standard deviation = 3.9; 66% women) were randomly assigned to one of the three conditions that involved viewing real-world, print e-cigarette ads. Two of the three conditions were experimental conditions where ads with different predominant themes (harm reduction [\"Health\"] versus social enhancement [\"Social\"] focused) were interspersed among ads of everyday objects. The third condition was the Control condition involving ads of everyday objects only. Participants provided data on explicit (ie, self-reported harm perceptions) and implicit (ie, Implicit Association Test) attitudes toward e-cigarette use and e-cigarette use intentions. Hypotheses were tested using structural equation modeling.
Relative to Control participants, participants in Health and Social conditions were more likely to show higher implicit attitudes toward e-cigarettes as a safer alternative to cigarettes. Only the Social condition, relative to Control, had a significant effect on lower explicit harm perceptions of e-cigarette versus cigarette use. The Social condition had a significant indirect effect on e-cigarette use susceptibility, mediated by explicit harm perceptions.
Social enhancement-themed ads may communicate the reduced harm messages more strongly among young adults so as to affect both explicit and implicit attitudes and, through these, e-cigarette use susceptibility. Regulatory bodies may need to scrutinize reduced harm claims communicated through social enhancement-themed ads.
The findings imply that implicit and explicit health benefit or reduced harm claims in e-cigarette marketing may be propagated via ads that use social enhancement gimmicks to attract youth and young adults. As the US Food and Drug Administration develops regulations on e-cigarette marketing, informed decisions need to be made that address harm reduction needs of current smokers as well as e-cigarette use onset among nonsmokers. In regard to the latter, e-cigarette marketing may need to be studied closely to monitor implicit and explicit health benefit claims that are coupled with the use of visual and textual gimmicks in ads that intend to make e-cigarettes more appealing to youth and young adults.
Journal Article
Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition
BackgroundThe main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can impair driving performance. Cannabidiol (CBD), a non-intoxicating cannabis component, is thought to mitigate certain adverse effects of THC. It is possible then that cannabis containing equivalent CBD and THC will differentially affect driving and cognition relative to THC-dominant cannabis.AimsThe present study investigated and compared the effects of THC-dominant and THC/CBD equivalent cannabis on simulated driving and cognitive performance.MethodsIn a randomized, double-blind, within-subjects crossover design, healthy volunteers (n = 14) with a history of light cannabis use attended three outpatient experimental test sessions in which simulated driving and cognitive performance were assessed at two timepoints (20–60 min and 200–240 min) following vaporization of 125 mg THC-dominant (11% THC; < 1% CBD), THC/CBD equivalent (11% THC, 11% CBD), or placebo (< 1% THC/CBD) cannabis.Results/outcomesBoth active cannabis types increased lane weaving during a car-following task but had little effect on other driving performance measures. Active cannabis types impaired performance on the Digit Symbol Substitution Task (DSST), Divided Attention Task (DAT) and Paced Auditory Serial Addition Task (PASAT) with impairment on the latter two tasks worse with THC/CBD equivalent cannabis. Subjective drug effects (e.g., “stoned”) and confidence in driving ability did not vary with CBD content. Peak plasma THC concentrations were higher following THC/CBD equivalent cannabis relative to THC-dominant cannabis, suggesting a possible pharmacokinetic interaction.Conclusions/interpretationCannabis containing equivalent concentrations of CBD and THC appears no less impairing than THC-dominant cannabis, and in some circumstances, CBD may actually exacerbate THC-induced impairment.
Journal Article
Real-Time Antecedents of Young Adults’ Vaping and Co-Vaping of Nicotine and Cannabis: An Ecological Momentary Assessment Study
Nicotine and cannabis vaping are common among young adults and can potentially lead to adverse health consequences. Identifying real-time antecedents of vaping events may provide insights into intervention targets pertinent to these behaviors. This study aimed to examine real-time antecedents of nicotine and cannabis vaping and same-occasion co-vaping among young adults.
This study aims to examine real-time antecedents of nicotine and cannabis vaping and same-occasion co-vaping among young adults.
We collected ecological momentary assessments (EMAs) via a smartphone app among California young adults (ages 18-29 y) in 2023-2024. Participants completed four random prompts each day for 30 consecutive days. Outcomes were defined as whether participants reported being about to vape nicotine, cannabis, or both substances (same-occasion co-vaping) in a given EMA. We used mixed-effects logistic regression models to examine real-time antecedents of each outcome.
Overall, 113 participants (mean age 23.8 y, SD3 y, 63% female, n=70) completed 9001 EMAs. Similar antecedents of all 3 vaping outcomes were craving and using alcohol. Increased cravings for a given substance were associated with a higher likelihood of vaping that substance or co-vaping. Craving for cannabis vaping was associated with lower odds of reporting nicotine vaping (adjusted odds ratio [AOR] 0.87, 95% CI 0.82-0.92). Feeling happier was associated with higher odds of reporting co-vaping (AOR 1.13, 95% CI 1.01-1.27) while feeling more stressed was associated with lower odds of vaping nicotine (AOR 0.95, 95% CI 0.91-0.98) or cannabis (AOR 0.91, 95% CI 0.86-0.97). Seeing tobacco advertisements was associated with higher odds of vaping nicotine (AOR 3.09, 95% CI 1.48-6.46) and co-vaping (AOR 4.15, 95% CI 1.18-14.52). Cannabis vaping was more likely to occur in the afternoon (AOR 1.52, 95% CI 1.16-1.98) and nighttime (AOR 1.95, 95% CI 1.45-2.63) than in the morning. Co-vaping was also more likely to occur in the afternoon (AOR 1.59, 95% CI 1.14-2.22) and nighttime (AOR 1.84, 95% CI 1.26-2.71) than in the morning, but the association was not held for nicotine vaping. Nicotine vaping was more likely to occur on weekends compared to weekdays (AOR 1.25, 95% CI 1.09-1.45), but no significant associations were found for cannabis vaping and co-vaping.
We found similar antecedents (craving and alcohol use) and unique antecedents (mood, advertising exposure, and time of day) for nicotine vaping, cannabis vaping, and same-occasion co-vaping, suggesting targets for future vaping cessation interventions.
Journal Article
Adolescents' interest in trying flavoured e-cigarettes
BackgroundMore US adolescents use e-cigarettes than smoke cigarettes. Research suggests flavoured e-cigarettes appeal to youth, but little is known about perceptions of and reasons for attraction to specific flavours.MethodsA national sample of adolescents (n=1125) ages 13–17 participated in a phone survey from November 2014 to June 2015. We randomly assigned adolescents to respond to survey items about 1 of 5 e-cigarette flavours (tobacco, alcohol, menthol, candy or fruit) and used regression analysis to examine the impact of flavour on interest in trying e-cigarettes and harm beliefs.ResultsAdolescents were more likely to report interest in trying an e-cigarette offered by a friend if it were flavoured like menthol (OR=4.00, 95% CI 1.46 to 10.97), candy (OR=4.53, 95% CI 1.67 to 12.31) or fruit (OR=6.49, 95% CI 2.48 to 17.01) compared with tobacco. Adolescents believed that fruit-flavoured e-cigarettes were less harmful to health than tobacco-flavoured e-cigarettes (p<0.05). Perceived harm mediated the relationship between some flavours and interest in trying e-cigarettes. A minority of adolescents believed that e-cigarettes did not have nicotine (14.6%) or did not know whether they had nicotine (3.6%); these beliefs did not vary by flavour.DiscussionCandy-flavoured, fruit-flavoured and menthol-flavoured e-cigarettes appeal to adolescents more than tobacco-flavoured or alcohol-flavoured e-cigarettes. This appeal is only partially explained by beliefs about reduced harm. Given adolescents' interest in trying e-cigarettes with certain flavours, policymakers should consider restricting advertisements promoting flavoured products in media that reach large numbers of young people. Future research should examine other reasons for the appeal of individual flavours, such as novelty and perceived luxury.
Journal Article
Development of the UNC Perceived Message Effectiveness Scale for Youth
PurposeTobacco prevention media campaigns are an important tool to address youth tobacco use. We developed a theory-based perceived message effectiveness (PME) Scale to use when vetting messages for campaigns.MethodsParticipants were a national sample of N=623 US adolescents (ages 13–17 years) recruited from a national probability-based panel. In an online experiment, we randomised adolescents to view tobacco prevention ads. All participants viewed an ad on smoking or vaping from the US Food and Drug Administration’s The Real Cost campaign and a control video, in a random order. After ad exposure, we assessed PME using nine candidate items and constructs for convergent and criterion validity analyses. We used confirmatory factor analysis and examined information curves to select the scale items.ResultsA brief PME scale with three items (α=0.95) worked equally well for demographically diverse adolescents with different patterns of tobacco use. The Real Cost ads generated higher PME scores than the control videos for both vaping and smoking (convergent validity; p<0.05). Higher PME scores were associated with greater attention, fear, cognitive elaboration and anticipated social interactions (convergent validity; r=0.31–0.66), as well as more negative attitudes toward and lower susceptibility to vaping and smoking (criterion validity; r=−0.14 to −0.37). A single-item PME measure performed similarly to the three-item version.ConclusionsThe University of North Carolina PME Scale for Youth is a reliable and valid measure of the potential effectiveness of vaping and smoking prevention ads. Employing PME scales during message development and selection may help youth tobacco prevention campaigns deploy more effective ads.
Journal Article
Assessing the reach and engagement of three anti-vaping messages on Facebook Targeting Australian Youth: a protocol for a randomised trial
Background
Vaping among 18-24-year-old Australians has increased from 5.8% in 2019 to 21% in 2023. This protocol describes a trial to investigate the dissemination and engagement achieved by three anti-vaping messages on Facebook.
Methods
This research employs a 3-arm randomised experimental design. Three distinct anti-vaping messages will be disseminated via Facebook using Meta Ads Manager. Each arm has a message that focuses on either health risks, environmental impact, or anti-vape industry sentiment. The campaign will run for three months. The primary outcome is the engagement rate as a measure of the effectiveness of anti-vaping message, and the secondary outcomes include network indicators: size, density, centralisation, and centrality to evaluate the extent to which the messages are disseminated. Participants will be randomly exposed to one of the three messages. Data on reach and engagement will be compared across the groups.
Discussion
This study will provide insights into the dissemination of social media-based anti-vaping campaigns. By evaluating engagement rates and network indicators, the research aims to identify which message themes engage most with young Australians. The findings will contribute to the development of more effective public health strategies for vaping cessation and prevention among youth.
Trial Registration
The study was registered on July 19th 2024 with the Australian New Zealand Clinical Trials Registry (ACTRN12624000885594).
Journal Article
A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy
In a randomized trial involving 886 smokers, e-cigarettes were more effective than nicotine-replacement therapy with respect to the 1-year abstinence rate (18% vs. 10%). Throat or mouth irritation was more common in the e-cigarette group, and nausea was more common in the nicotine-replacement group.
Journal Article