Characterizing Polytobacco Use Trajectories and Their Associations With Substance Use and Mental Health Across Mid-Adolescence.

Background:Polytobacco product use is suspected to be common, dynamic across time, and increase risk for adverse behavioral outcomes. We statistically modeled characteristic types of polytobacco use trajectories during mid-adolescence and tested their prospective association with substance use and mental health problems. Methods:Adolescents (N = 3393) in Los Angeles, CA, were surveyed semiannually from 9th to 11th grade. Past 6-month combustible cigarette, e-cigarette, or hookah use (yes/no) over four assessments were analyzed using parallel growth mixture modeling to identify a parsimonious set of polytobacco use trajectories. A tobacco product use trajectory group was used to predict substance use and mental health at the fifth assessment. Results:Three profiles were identified: (1) tobacco nonusers (N = 2291, 67.5%) with the lowest use prevalence (<3%) of all products across all timepoints; (2) polyproduct users (N = 920, 27.1%) with moderate use prevalence of each product (8-35%) that escalated for combustible cigarettes but decreased for e-cigarettes and hookah across time; and (3) chronic polyproduct users (N = 182, 5.4%) with high prevalence of each product use (38-86%) that escalated for combustible cigarettes and e-cigarettes. Nonusers, polyproduct users, and chronic polyproduct users reported successively higher alcohol, marijuana, and illicit drug use and ADHD at the final follow-up, respectively. Both tobacco using groups (vs. nonusers) reported greater odds of depression and anxiety at the final follow-up but did not differ from each other. Conclusions:Adolescent polytobacco use may involve a common moderate risk trajectory and a less common high-risk chronic trajectory. Both trajectories predict substance use and mental health symptomology. Implications:Variation in use and co-use of combustible cigarette, e-cigarette, and hookah use in mid-adolescence can be parsimoniously characterized by a small set common trajectory profiles in which polyproduct use are predominant patterns of tobacco product use, which predict adverse behavioral outcomes. Prevention and policy addressing polytobacco use (relative to single product use) may be optimal tobacco control strategies for youth, which may in turn prevent other forms of substance use and mental health problems

E‐cigarette price sensitivity among middle‐ and high‐school students: evidence from monitoring the future

AimsWe estimated associations between e‐cigarette prices (both disposable and refill) and e‐cigarette use among middle and high‐school students in the United States. We also estimated associations between cigarette prices and e‐cigarette use.DesignWe used regression models to estimate the associations between e‐cigarette and cigarette prices and e‐cigarette use. In our regression models, we exploited changes in e‐cigarette and cigarette prices across four periods of time and across 50 markets. We report the associations as price elasticities. In our primary model, we controlled for socio‐demographic characteristics, cigarette prices, tobacco control policies, market fixed effects and year‐quarter fixed effects.SettingUnited States of America.ParticipantsA total of 24 370 middle‐ and high‐school students participating in the Monitoring the Future Survey in years 2014 and 2015.MeasurementsSelf‐reported e‐cigarette use over the last 30 days. Average quarterly cigarette prices, e‐cigarette disposable prices and e‐cigarette refill prices were constructed from Nielsen retail data (inclusive of excise taxes) for 50 US markets.FindingsIn a model with market fixed effects, we estimated that a 10% increase in e‐cigarette disposable prices is associated with a reduction in the number of days vaping among e‐cigarette users by approximately 9.7% [95% confidence interval (CI) = −17.7 to 1.8%; P = 0.02] and is associated with a reduction in the number of days vaping by the full sample by approximately 17.9% (95% CI = −31.5 to −4.2%; P = 0.01). Refill e‐cigarette prices were not statistically significant predictors of vaping. Cigarette prices were not associated significantly with e‐cigarette use regardless of the e‐cigarette price used. However, in a model without market fixed effects, cigarette prices were a statistically significant positive predictor of total e‐cigarette use.ConclusionsHigher e‐cigarette disposable prices appear to be associated with reduced e‐cigarette use among adolescents in the US.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143795/1/add14119_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143795/2/add14119.pd

Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults a systematic review and meta-analysis

IMPORTANCE The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. OBJECTIVE To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. DATA SOURCES PubMed, EMBASE, Cochrane Library,Web of Science, the 2016 Society for Research on Nicotine and Tobacco 22nd Annual Meeting abstracts, the 2016 Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions abstracts, and the 2016 National Institutes of Health Tobacco Regulatory Science Program Conference were searched between February 7 and February 17, 2017. The search included indexed terms and text words to capture concepts associated with e-cigarettes and traditional cigarettes in articles published from database inception to the date of the search. STUDY SELECTION Longitudinal studies reporting odds ratios for cigarette smoking initiation associated with ever use of e-cigarettes or past 30-day cigarette smoking associated with past 30-day e-cigarette use. Searches yielded 6959 unique studies, of which 9met inclusion criteria (comprising 17 389 adolescents and young adults). DATA EXTRACTION AND SYNTHESIS Study quality and risk of biaswere assessed using the Newcastle-Ottawa Scale and the Risk of Bias in Non-randomized Studies of Interventions tool, respectively. Data and estimates were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES Among baseline never cigarette smokers, cigarette smoking initiation between baseline and follow-up. Among baseline non-past 30-day cigarette smokers who were past 30-day e-cigarette users, past 30-day cigarette smoking at follow-up. RESULTS Among 17 389 adolescents and young adults, the ages ranged between 14 and 30 years at baseline, and 56.0%were female. The pooled probabilities of cigarette smoking initiationwere 30.4%for baseline ever e-cigarette users and 7.9%for baseline never e-cigarette users. The pooled probabilities of past 30-day cigarette smoking at follow-upwere 21.5%for baseline past 30-day e-cigarette users and 4.6%for baseline non-past 30-day e-cigarette users. Adjusting for knowndemographic, psychosocial, and behavioral risk factors for cigarette smoking, the pooled odds ratio for subsequent cigarette smoking initiationwas 3.62 (95%CI, 2.42-5.41) for ever vs never e-cigarette users, and the pooled odds ratio for past 30-day cigarette smoking at follow-up was 4.28 (95%CI, 2.52-7.27) for past 30-day e-cigarette vs non-past 30-day e-cigarette users at baseline.Amoderate level of heterogeneitywas observed among studies (I2 = 60.1%). CONCLUSIONS AND RELEVANCE e-Cigarette use was associated with greater risk for subsequent cigarette smoking initiation and past 30-day cigarette smoking. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking

E-cigarettes and urologic health: a collaborative review of toxicology, epidemiology, and potential risks

Context: Use of electronic cigarettes (ECs) is on the rise in most high-income countries. Smoking conventional cigarettes is a known risk factor for urologic malignancy incidence, progression, and mortality, as well as for other urologic health indicators. The potential impact of EC use on urologic health is therefore of clinical interest to the urology community. Objective: To review the available data on current EC use, including potential benefits in urologic patients, potential issues linked to toxicology of EC constituents, and how this might translate into urologic health risks. Evidence acquisition: A Medline search was carried out in August 2016 for studies reporting urologic health outcomes and EC use. Snowballing techniques were also used to identify relevant studies from recent systematic reviews. A narrative synthesis of data around EC health outcomes, toxicology, and potential use in smoking cessation and health policy was carried out. Evidence synthesis: We found no studies to date that have been specifically designed to prospectively assess urologic health risks, even in an observational setting. Generating such data would be an important contribution to the debate on the role of ECs in public health and clinical practice. There is evidence from a recent Cochrane review of RCTs that ECs can support smoking cessation. There are emerging data indicating that potentially harmful components of ECs such as tobacco-specific nitrosamines, polyaromatic hydrocarbons, and heavy metals could be linked to possible urologic health risks. Conclusions: ECs might be a useful tool to encourage cessation of conventional cigarette smoking. However, data collection around the specific impact of ECs on urologic health is needed to clarify the possible patient benefits, outcomes, and adverse events. Patient summary: While electronic cigarettes might help some people to stop smoking, their overall impact on urologic health is not clear. While electronic cigarettes might help some people to stop smoking, it is not clear if they may be bad for urologic health