Risk Associated with E-Cigarette Use and Marketing Messages on Other Tobacco Products Use and Dependence Symptoms among Adolescents

E-cigarettes became available in the United States during 2007. Studies using national data have found an increase in e- cigarette use among adolescents as early as 2011. In 2014, e-cigarettes became the most commonly used tobacco product among adolescents; however, little is known about its association with other tobacco products use. Therefore, the present study aimed to: 1) Examine the association between initiating tobacco use via e-cigarettes and subsequent use of other tobacco products; 2) Examine the association between the exposure to e-cigarettes marketing messages and tobacco use; 3) Describe symptoms of nicotine dependence associated with e-cigarette use, compared with cigarette and dual use of e-cigarettes and cigarettes. All aims were carried out among data from the National Youth Tobacco Survey (NYTS) 2014 and 2015. The participants of NYTS were adolescents, and they self-reported their demographic characteristics and tobacco use in an anonymous 81-item pencil-paper questionnaire. Findings from logistic regression modeling showed that initiating tobacco use via e-cigarettes was significantly associated with subsequent current use of cigarettes (adjusted odds ratio (AOR)=2.7; 95% confidence interval [CI], 1.9-4.0), cigars (AOR= 1.7; 95% CI, 1.2-2.4), smokeless tobacco (AOR= 3.1; 95% CI, 2.2-5.4), or any tobacco products (AOR= 4.4; 95% CI, 3.5-5.6). In addition, living with someone who used e-cigarettes at home significantly increased the likelihood of using tobacco products. Notably, e-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco (i.e. more than one tobacco product) use (AOR: 1.8, 95% CI: 1.5-2.1). Among adolescent daily tobacco users, 35.6% of e-cigarette users and 85.3% of cigarette users reported one or more dependence symptoms. These proportions increased to 74.3% among e-cigarette and 93.3% of cigarette dual (i.e. combined) users. Strong craving was the most commonly reported symptom with a range of 16.1-58.9% among different types of smokers in the study. In conclusion, exposure to e-cigarette marketing messages and e-cigarette use were associated with use of other tobacco products. Furthermore, e-cigarette use is addictive. Despite cigarette and dual (i.e. e-cigarette and cigarette) users being more likely to report dependence symptoms than e-cigarette users, the addictiveness of e-cigarettes occurred at appreciable rates. Collectively, the findings suggest that e-cigarettes are associated with dependence symptoms and use of tobacco products and suggest that stricter regulations are needed to prevent adolescent access to and use of e-cigarettes

Risk Associated with E-cigarette Use and Marketing Messages on Other Tobacco Products Use and Dependence Symptoms among Adolescents in the United States

E-cigarettes became available in the United States during 2007. Studies using national data have found an increase in e- cigarette use among adolescents as early as 2011. In 2014, e-cigarettes became the most commonly used tobacco product among adolescents; however, little is known about its association with other tobacco products use. Therefore, the present study aimed to: 1) Examine the association between initiating tobacco use via e-cigarettes and subsequent use of other tobacco products; 2) Examine the association between the exposure to e-cigarettes marketing messages and tobacco use; 3) Describe symptoms of nicotine dependence associated with e-cigarette use, compared with cigarette and dual use of e-cigarettes and cigarettes. All aims were carried out among data from the National Youth Tobacco Survey (NYTS) 2014 and 2015. The participants of NYTS were adolescents, and they self-reported their demographic characteristics and tobacco use in an anonymous 81-item pencil-paper questionnaire.^ Findings from logistic regression modeling showed that initiating tobacco use via e-cigarettes was significantly associated with subsequent current use of cigarettes (adjusted odds ratio (AOR)=2.7; 95% confidence interval [CI], 1.9-4.0), cigars (AOR= 1.7; 95% CI, 1.2-2.4), smokeless tobacco (AOR= 3.1; 95% CI, 2.2-5.4), or any tobacco products (AOR= 4.4; 95% CI, 3.5-5.6). In addition, living with someone who used e-cigarettes at home significantly increased the likelihood of using tobacco products. Notably, e-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco (i.e. more than one tobacco product) use (AOR: 1.8, 95% CI: 1.5-2.1). Among adolescent daily tobacco users, 35.6% of e-cigarette users and 85.3% of cigarette users reported one or more dependence symptoms. These proportions increased to 74.3% among e-cigarette and 93.3% of cigarette dual (i.e. combined) users. Strong craving was the most commonly reported symptom with a range of 16.1-58.9% among different types of smokers in the study.^ In conclusion, exposure to e-cigarette marketing messages and e-cigarette use were associated with use of other tobacco products. Furthermore, e-cigarette use is addictive. Despite cigarette and dual (i.e. e-cigarette and cigarette) users being more likely to report dependence symptoms than e-cigarette users, the addictiveness of e-cigarettes occurred at appreciable rates. Collectively, the findings suggest that e-cigarettes are associated with dependence symptoms and use of tobacco products and suggest that stricter regulations are needed to prevent adolescent access to and use of e-cigarettes.

Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting

Objectives: To identify predictors of nicotine withdrawal symptoms among smokers who participated in a randomized cessation trial in a low-income country. Methods: We analyzed data from 269 smokers who participated in a randomized, placebo-controlled smoking cessation trial conducted in primary healthcare in Aleppo, Syria. All participants received behavioral counseling and were randomized to receive either 6 weeks of nicotine or placebo patch and were followed for one year. Results: Throughout the study, lower total withdrawal score was associated with greater education (p = 0.044), older age of smoking initiation (p = 0.017), lower nicotine dependence (p = 0.024), higher confidence in ability to quit (p = 0.020), lower reported depression (p \u3c 0.001), higher adherence to patch (p = 0.026), belief of receiving nicotine patches rather than placebo (p = 0.011), and waterpipe use (p = 0.047). Conclusions: Lower nicotine dependence, greater educational attainment, higher confidence in ability to quit and waterpipe use predict lower withdrawal severity. Waterpipe smoking may serve as a barrier to smoking cessation efforts in countries where its use is highly prevalent. Further, expectancies about the effects of pharmacotherapy appear to mediate the experience of nicotine withdrawal

Deaths Due to Screenable Cancers Among People Living With HIV Infection, Florida, 2000-2014

INTRODUCTION: Because of antiretroviral therapy, people living with HIV infection are surviving longer and are at higher risk for chronic diseases. This study's objective was to assess the magnitude of deaths due to cancers for which there are screening recommendations for people living with HIV in Florida. METHODS: Florida Department of Health Enhanced HIV/AIDS Reporting System data were matched with Department of Health Vital Records and the National Death Index to identify deaths and their causes through 2014. The sex-specific and cause-specific mortality rates and indirect standardized mortality ratios (SMRs, using U.S. mortality rates as a standard) were calculated during 2016 for people reported with HIV infection 2000-2014.RESULTS: Despite the competing risk of HIV mortality, among the 25,678 females, there was a higher risk of cervical (SMR=6.32, 95% CI=4.63, 8.44), colorectal (SMR=2.05, 95% CI=1.44, 2.83), liver (SMR=8.96, 95% CI=5.39, 14.03), and lung (SMR=5.82, 95% CI=4.80, 6.96) cancer mortality and lower risk of breast cancer mortality (SMR=0.57, 95% CI=0.42, 0.76). Among 63,493 males, there was a higher risk of liver (SMR=5.50, 95% CI=4.47, 6.70) and lung (4.63, 95% CI=4.11, 5.19) cancer mortality. Among males, the lung cancer SMR significantly declined 2000-2014 (p&lt;0.05), but was still high in 2012-2014 (SMR=3.59, 95% CI=2.87, 4.43). CONCLUSIONS: These results indicate the importance of primary and secondary cancer prevention during primary care for people living with HIV infection.</p

Associations of ethnic discrimination with symptoms of anxiety and depression among Hispanic emerging adults: a moderated mediation model

Background and Objectives: Emerging adulthood is often marked with elevated symptoms of anxiety and depression. Hispanic emerging adults may face cultural stressors such as ethnic discrimination that further increase levels of anxiety and depression symptoms. The study aims were to examine if (a) self-esteem mediated effects of ethnic discrimination on symptoms of anxiety and depression, and (b) if gender moderated the indirect effects of discrimination. Design: The study design was cross-sectional self-report. Method: Two moderated mediation models were tested, with 1084 Hispanic emerging adults (ages 18-25) enrolled in institutions of post-secondary in the United States. Results: Results indicated that (a) higher ethnic discrimination was associated with higher anxiety symptoms (β = .05, p = .04), higher depression symptoms (β = .06, p = .02), and lower self-esteem (β = −.30, p < .001); (b) self-esteem mediated the associations of ethnic discrimination with anxiety and depression symptoms; and (c) gender moderated the indirect effects of discrimination, whereby self-esteem was a stronger mediator among men than women. Each moderated mediation model explained 26% of variability in symptoms of anxiety and depression, respectively. Conclusions: Findings suggest that the mediating effects of self-esteem linking ethnic discrimination with symptoms of anxiety and depression vary between genders