CHARACTERIZING YOUNG ADULT EXPOSURE AND ENGAGEMENT WITH SOCIAL MEDIA TOBACCO AND NICOTINE PRODUCT MARKETING AND MESSAGING

Tobacco use remains a critical public health issue in the United States. Young adults are disproportionately affected by high rates of tobacco use and heavily targeted by tobacco marketing. Social media has become an important source of exposure to tobacco and nicotine product marketing and messaging for young adults. This dissertation examined the prevalence and socio-environmental characteristics associated with young adults’ exposure to and engagement with tobacco-related social media (paper 1); the prospective associations between young adults’ exposure and engagement and tobacco and nicotine product use (paper 2); and young adults’ experiences with tobacco and nicotine product messaging on social media, as well as perceptions of existing e-cigarette social media advertisements (paper 3). Participants were two- and four-year college students from the Marketing and Promotions across Colleges in Texas Study (n=4,384; mean age=20.4, standard deviation=2.32; 64.6% female; 35.5% non-Hispanic white, 30.8% Hispanic, 18.2% Asian, 7.9% African American/black, and 7.6% another race/ethnicity or multi-racial). In paper 1, 30% of students reported past 30-day exposure to cigarette, e-cigarette, hookah, cigar, and/or smokeless tobacco advertising on Facebook, YouTube, Instagram, Twitter, Snapchat, Reddit, and/or Pinterest, and 23% of students reported engagement. Anti-engagement activities such as posting links to anti-tobacco messaging were more prevalent than pro-engagement. Racial/ethnic minorities, dual- and poly-users, higher social media users, students with friends that use tobacco, and students with higher depressive symptoms were significantly more likely to report exposure. Racial/ethnic minorities, two-year college students, poly- and dual-users, higher social media users, and students with higher depressive symptoms were more likely to report pro-engagement. Poly-users, higher social media users, students with friends that use tobacco, and students with higher depressive symptoms were more likely to report anti-engagement. In paper 2, multiple logistic regression analyses revealed exposure to and engagement with tobacco-related social media significantly predicted past 30-day use of e-cigarettes, cigars, and hookah at one-year follow up. Controlling for other social media, exposure to any product advertising via Reddit predicted e-cigarette use. Pinterest exposure predicted cigar use. Snapchat exposure predicted hookah use. Pro-tobacco engagement predicted future use of all products. Anti-tobacco engagement predicted use of cigars and hookah. In paper 3, thematic content analysis of qualitative interviews with a subsample of 30 revealed all participants recalled seeing tobacco or nicotine product messaging on social media, primarily for alternative products like e-cigarettes and hookah. Perceptions of researcher-selected advertisements were generally positive, with students preferring advertisements that did not look like traditional advertisements and conveyed fun and social themes. Findings support a critical need for social media-based federal regulation, countermarketing and health communication campaigns, and intervention focused on tobacco

Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013

Citation: Meyer, M. R. U., Perry, C. K., Sumrall, J. C., Patterson, M. S., Walsh, S. M., Clendennen, S. C., . . . Valko, C. (2016). Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013. Preventing Chronic Disease, 13, 24. doi:10.5888/pcd13.150406Additional Authors: Valko, C.Introduction Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity-related policy and environmental strategies for obesity prevention in rural communities. Methods A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity-related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers. Results Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were "enhance infrastructure supporting walking" (n = 11) and " increase opportunities for extracurricular physical activity" (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes. Conclusion Seven of the 12 COCOMO physical activity-related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities

Socio-ecological risk factors of hospital readmission in an underserved population.

Hospital readmissions are costly, preventable, and currently a significant focus of healthcare reform. The Hospital Readmissions Reduction Program, an Affordable Care Act initiative, financially penalizes hospitals for excessive readmissions based on the premise that it will incentivize hospitals and physicians to provide higher quality patient care. The purpose of this study was to compare socio-ecological risk factors of hospital readmission among 30, 60, and 90 day readmission groups in an underserved population. A retrospective secondary data analysis was conducted using electronic patient medical records from twelve central Texas acute care facilities that serve patients living below 200% of the federal poverty guideline. Eight factors were analyzed as correlates of hospital readmission among 30, 60, and 90 day readmissions groups. A longer time period in days between the initial hospital encounter and the follow-up visit as well as being of the female sex were associated with 60 or 90 day readmission compared to 30 day readmission. In the dawn of policy reform targeted at reducing hospital readmissions, factors that determine readmission risk must be examined. Clarification of the relationships between risk factors and readmission groups can help inform future policy and practice.M.P.H

Symptoms of Depression and Anxiety are Associated with Substances Used in Electronic Nicotine Delivery Systems (ENDS): A Longitudinal Analysis from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS)

Introduction Electronic nicotine delivery systems (ENDS) use with nicotine or THC among adolescents and young adults is increasing. The goal of our research was to examine relationships between symptoms of anxiety or depression and ENDS use, whether with nicotine or THC, among young people in four major metropolitan areas of Texas. Methods The sample was 57.6% female and 37.6% Hispanic. Data were derived from Wave 9 (Spring, 2019) and Wave 10 (Fall, 2019) of the Texas Adolescent Tobacco and Marketing Surveillance system. Logistic regression analyses examined associations between symptoms of depression, anxiety, or comorbid depression and anxiety in the Spring, 2019 and use of nicotine or THC in ENDS in Fall, 2019, controlling for sociodemographic characteristics and use of ENDS in Fall, 2019. Results Past 30-day ENDS use in Wave 10 was 11.6% with nicotine and 12.4% with THC. Symptoms of anxiety were present in 4.9% of young people, depression in 7.9%, and comorbid depression and anxiety in 15.2%. In stratified analyses, symptoms of anxiety alone at Wave 9 were related to increased odds of past 30-day use of ENDS with nicotine among individuals one-year post-high school at Wave 10 (PPPPPP\u3c0.01). Discussion Results suggest symptoms of comorbid depression and anxiety may be particularly important in future use of ENDS with THC

Symptoms of Depression and Anxiety and Subsequent Use of Nicotine and THC in Electronic Cigarettes

Background: This study examines whether symptoms of depression, anxiety, or comorbid depression and anxiety are associated with future use of nicotine or THC in e-cigarettes. Methods: Data were from an online survey of youth and young adults in urban areas of Texas with complete data (n = 2,307) in spring 2019 (baseline) and spring 2020 (12-month follow-up). Multivariable logistic regression models examined associations between self-reported symptoms of depression, anxiety, or comorbid depression and anxiety at baseline and past 30-day e-cigarette use with nicotine or THC at 12-month follow-up. Analyses adjusted for baseline demographics and baseline past 30-day e-cigarette, combustible tobacco, marijuana, and alcohol use and stratified by race/ethnicity, gender, grade level, and SES. Results: Participants were 16-23 years old, 58.1% female and 37.9% Hispanic. At baseline, 14.7% reported symptoms of comorbid depression and anxiety, 7.9% depression, and 4.7% anxiety. Prevalence of past 30-day e-cigarette use at 12-month follow-up was 10.4% with nicotine and 10.3% with THC. Symptoms of depression and comorbid depression and anxiety at baseline were significantly associated with both nicotine and THC use in e-cigarettes 12 months later. Symptoms of anxiety were associated with nicotine use in e-cigarettes 12 months later. Conclusions: Symptoms of anxiety and depression may be important indicators of future nicotine and THC vaping among young people. Clinicians should be aware of groups most at risk who may benefit from substance use counseling and intervention

Cannabis vaping among youth and young adults: a scoping review.

Purpose of review: The purpose of this review was to describe the state-of-the-literature on research specific to cannabis vaping among youth and young adults. Recent Findings: Out of 1801 records identified, a total of 202 articles met eligibility criteria for inclusion in this review. Most of this literature (46.0% of studies) was specific to the health effects of cannabis vaping, particularly EVALI (e-cigarette and vaping associated lung injury). Other research areas identified in the review included the etiology (24.3%) and epidemiology (24.8%) of cannabis vaping, in addition to articles on regulation (8.4%) and marketing (5.5%) of the same. Summary: Cannabis vaping is increasingly common among youth and young adults and more prevalent is settings where recreational use for adults has been legalized. The literature documents a number of negative health effects of cannabis vaping for young people, along with risk factors and reasons for the same

Research on Youth and Young Adult Tobacco Use, 2013–2018, From the Food and Drug Administration–National Institutes of Health Tobacco Centers of Regulatory Science

The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior.ImplicationsThe Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science