Perceptions of Relative Risk of Snus and Cigarettes Among US Smokers

In a survey of 1836 adult US smokers, when using a direct comparison measure, 22.1% reported snus was less harmful than were cigarettes. When asked indirectly (estimating the health risk of snus and cigarettes in 2 separate questions and comparing the answers to each other), 51.6% rated snus as less risky. The Food and Drug Administration should consider both direct and indirect measures when perceived risk data are presented as evidence for tobacco regulation.IN JULY 2011, THE RJ REYNOLDS Tobacco Company submitted a citizen petition to the US Food and Drug Administration requesting that it change one of the smokeless tobacco warning labels from “WARNING: This product is not a safe alternative to cigarettes” to “WARNING: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes.”1 This request referred to studies2–7 reporting that a large portion of the public perceives smokeless tobacco products to be as harmful as or more harmful than cigarettes.A closer look at the studies that report perceptions of comparative risk between smokeless tobacco and cigarettes2–7 shows that most of them3–6 employed a direct measure of comparative harm, which elicits estimates of relative harm of smokeless tobacco and cigarettes within a single question (e.g., Compared to regular cigarettes, are smokeless tobacco products less harmful, as harmful, or more harmful?). However, 2 studies2,7 used an indirect method: measuring the perceived harm of cigarettes and smokeless tobacco in 2 separate questions and then comparing the answers. Studies employing direct methods found that 7% to 25% of participants rated smokeless tobacco as less harmful than cigarettes. By contrast, studies using indirect methods found that a much larger proportion (41%–49%) of participants rated smokeless tobacco as less dangerous than cigarettes.This evidence suggests that different measures of perceived relative harm—direct and indirect—produce different estimates. However, other explanations for the different estimates besides measurement artifacts cannot be ruled out by comparing data from different studies. To determine whether different measures produce different answers, we used both direct and indirect measures of perceived relative harm in the same study. We measured the perceived relative harm of cigarettes and snus (finely ground smokeless tobacco packed in small porous pouches to be placed between gum and lip). Snus is a relatively recent addition to the US smokeless tobacco market,8 and some argue it should be promoted for harm reduction.9 Swedish snus has been reported to carry lower health risks than do cigarettes,10 but because the product labeled snus in the United States is manufactured, stored, and used differently than is Swedish snus, the health risks of the US snus products are unknown.     

Perceptions of Heated Tobacco Products (HTPs) and Intention to Quit Among Adult Tobacco Users in Korea

BackgroundThe popularity of heated tobacco products (HTPs) has been growing globally but, limited information exists on tobacco use behaviors and its impact on tobacco control. This study investigates awareness and perception of HTPs among tobacco users and whether perceptions of HTPs are associated with HTP use and intention to quit.MethodsWe invited 2,000 tobacco users aged 19–65 years with countrywide representation to an online survey in November 2018. Information on general characteristics, tobacco use behaviors, awareness and perception of HTPs, and intention to quit were gathered. Multinomial logistic regression analysis and ANCOVA were used for estimation of association and comparison.ResultsAmong all tobacco users, 36.8% were classified as ever users, whereas 28.3% had used HTPs in the past 30 days, which was higher than expected. Users of liquid-based e-cigarettes (odds ratio [OR] 1.578; 95% confidence interval [CI], 1.210–2.056) and poly-product users (OR 2.029; 95% CI, 1.121–3.671) showed higher intention to quit within 1 month when compared to users of conventional cigarettes (CCs), whereas HTP users and dual product users did not. HTP users rated HTPs more favorably than CCs in terms of smoke, smell, harm, aid in quitting, design, and price than users of other products did (P-value < 0.001).ConclusionWe find that positive perception of HTPs following strategic marketing from tobacco companies could have contributed to a greater increase in HTP use than expected in Korea. However, HTPs might not be considered substitutes for CCs for quitting tobacco use because a significant proportion of dual product users reported a lower intention to quit.Key words: heated tobacco products, IQOS, harm reduction, intention to quit, advertising and promotion     

吸烟的流行、危害与戒烟

吸烟是人类文明史上的一个奇特现象.当今社会吸烟即烟草滥用导致烟草依赖,是一种普遍的、与高血压和糖尿病不同的慢性高复发性疾病.吸烟是人类最大的公害[1].履行<公约>,控制烟草危害,禁止吸烟,已成国际共识.     

Positive Association between Resting Pulse and Cancer Incidence in Current and Former Smokers

PURPOSE: To evaluate the association between resting pulse and cancer incidence in older persons.METHODS: A cohort of 2819 persons, aged 65 to 102 years at baseline, was followed for the development of cancer from 1982 through 1993 by linkage to a statewide cancer registry; 494 incident cases were identified. Resting radial pulse (beats per minute) was measured during an in-person interview at baseline, and sex-specific quintile cutpoints were used in the analysis.RESULTS: After adjustment for age, body mass, smoking, and physical activity, there was a positive association between pulse and cancer incidence in men: compared to men with a pulse of < 63, men with a pulse of 63–68 (relative risk (RR); 95% confidence interval (CI): RR = 1.68; CI = 1.06–2.66), 69–74 (RR = 1.54; CI = 0.95–2.49), 75–82 (RR = 1.62; CI = 1.03–2.55), and > 82 (RR = 1.63; CI = 1.03–2.65) were at elevated risk for any cancer. This association remained unchanged after further adjustment for cardiovascular comorbidity, diabetes, alcohol use, high level of depressive symptoms, and low self-perceived health status. Exclusion of cases diagnosed in the first two years of follow-up did not alter the association. There was no overall association between pulse and cancer incidence in women. Analyses stratified by smoking status showed that the pulse and cancer association was strongest in ever smokers for both men and women. In subsite analysis for men, pulse was mainly associated with smoking-related tumors as a group and colorectal and prostate cancer.CONCLUSIONS: These data suggest that resting pulse is associated with cancer incidence, mainly among ever smokers.     

Reasons for Self-Medication and Perceptions of Risk Among Mexican Migrant Farm Workers

Although the frequency of self-medication among Mexican migrants has been well-documented in the public health literature, the multiple reasons for this practice are poorly understood. Most studies point to migrants' cultural preferences for Mexican medications, their prior experiences in countries where antibiotics are loosely regulated, and their lack of access to health care as the primary factors behind their self-medication. Based on participant observation and in-depth interviews with 23 Mexican migrants in a farm working community in the interior of California, we argue that occupational vulnerability is an equally important factor that encourages self-medication. All 23 of our interviewees reported having engaged in some degree of self-medication, notable in this location 8 h from the US-Mexico border. Among interviewees, occupational vulnerability represented an even more important factor influencing self-medication than lack of health insurance or lack of legal documentation. While interviewees did express a preference for Mexican medications as more potent and effective, this did not necessarily translate to a preference for using them without a doctor's supervision. Finally, we show that rather than remaining unaware of the risks of following this custom "transported from Latin America", Mexican migrants devised an elaborate hierarchy of resort of the safest self-medication practices to follow.     

Smoking Prevalence,Knowledge and Perceptions on Tobacco Control Among Healthcare Professionals: A Survey in an Italian Cancer Center

Smoking is recognized as the major cause of lung cancer. Healthcare professionals play an important role in lung cancer prevention policies, as they act as a source of guidance for patients and advocates. The following survey evaluated prevalence, knowledge, and attitudes toward tobacco smoking among a sample of workers in “IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, an Italian cancer hospital. An anonymous questionnaire was completed by 104 healthcare professionals to collect personal and occupational data about smoking status, knowledge about the harms of smoking, current legislation in place, Second-Hand Smoke (SHS) awareness, and, for ex-smokers, the reasons for quitting. Among participants, 17.8% were current smokers, 26.2% former smokers, and 56% never smoked. Only 40% acknowledged that the smoking ban is generally respected, and 63.2% reported that they smoke during working hours. Most of the participants perceived tobacco control policy as an efficient way to protect public health. Currently, the implementation of Italian anti-smoking legislation has so far improved neither smoking cessation rates nor the will to quit smoking completely. Our experience highlights that to date the anti-smoking strategies have limited efficacy even in a cancer center; in fact, there is still a large prevalence of smokers among hospital personnel. Therefore, it is strongly suggested that interventions be shared with all healthcare workers, specifically aimed at developing a culture of health promotion.

     

Perceived Effectiveness of Antismoking Ads and Association with Quit Attempts Among Smokers: Evidence from the Tips From Former Smokers Campaign

Background. Measures of perceived effectiveness (PE) of ads have been validated to predict changes in cognitive precursors of quit attempts, but a relationship between PE and actual quit attempts has not been shown in population-based studies. We analyzed smokers’ PE ratings of ads from the national Tips From Former Smokers (Tips) campaign to (1) establish the validity of PE in predicting quit attempts in a large, nationally representative sample of smokers; (2) identify behavioral and demographic correlates of PE among respondents; and (3) examine whether PE is influenced by matching the race/ethnicity of ad participants with that of the ad viewer.Methods. We used survey data from two waves (baseline and follow-up) of a longitudinal online cohort of adult U.S. cigarette smokers. Respondents were shown one or more of 14 Tips campaign ads and were asked to assess each ad in terms of PE. We used multivariate models to estimate the association between baseline PE and prospective quit attempts; cross-sectional associations between PE and various respondent characteristics, including race/ethnicity, desire to quit, and health conditions; and the association between race/ethnicity of respondents and Tips ad participants.Results. Higher PE at baseline was associated with increased odds of a quit attempt at follow-up. Higher PE scores were associated with non-Hispanic black race, Hispanic ethnicity, higher desire to quit, presence of a chronic health condition, and presence of a mental health condition. There was no relationship between PE scores and matched race/ethnicity of the respondent and Tips ad participants.Conclusions. This is the first study to demonstrate an association between PE scores for antismoking ads and prospective quit attempts in a large, nationally representative sample of smokers. Our findings also provide strong evidence that racial/ethnic minority subpopulations, including non-Hispanic blacks and Hispanics, react more favorably to Tips campaign ads irrespective of race/ethnicity of the ad participant. This suggests that message characteristics (e.g., graphic visuals and emotional content) may play a more important role in PE than race/ethnicity of ad participants.     

Prospective Study of Physical Activity and Lung Cancer by Histologic Type in Current, Former, and Never Smokers

Increased physical activity has been associated with decreasedlung cancer risk. However, no previous investigation has examinedphysical activity in relation to lung cancer histologic typesby smoking status. The authors investigated these relationsin the National Institutes of Health–AARP Diet and HealthStudy among 501,148 men and women aged 50–71 years atbaseline in 1995–1996. During follow-up to 2003, 6,745lung carcinomas occurred (14.8% small cell, 40.3% adenocarcinoma,19.7% squamous cell, 6.1% undifferentiated large cell, 7.2%non-small cell not otherwise specified, and 11.8% carcinomanot otherwise specified). Among former smokers, the multivariaterelative risks of small cell, adenocarcinoma, squamous cell,and undifferentiated large cell carcinomas comparing the highestwith the lowest activity level (5 times/week vs. inactive) were0.93 (95% confidence interval (CI): 0.67, 1.28), 0.79 (95% CI:0.67, 0.94), 0.73 (95% CI: 0.57, 0.93), and 0.61 (95% CI: 0.38,0.98), respectively. Among current smokers, corresponding valueswere 0.77 (95% CI: 0.58, 1.02), 0.76 (95% CI: 0.61, 0.95), 0.85(95% CI: 0.65, 1.11), and 1.10 (95% CI: 0.69, 1.78). In contrast,physical activity was unrelated to lung carcinoma among neversmokers (P_interaction between physical activity and smokingfor total lung carcinomas = 0.002). The inverse findings amongformer and current smokers in combination with the null resultsfor physical activity among never smokers may point toward residualconfounding by cigarette smoking as an explanation for the relationsobserved. lung neoplasms; motor activity; neoplasms by histologic type; prospective studies; smoking     

Tobacco Retailer Proximity and Density and Nicotine Dependence Among Smokers With Serious Mental Illness

Objectives. We examined the density and proximity of tobacco retailers and associations with smoking behavior and mental health in a diverse sample of 1061 smokers with serious mental illness (SMI) residing in the San Francisco Bay Area of California.Methods. Participants’ addresses were geocoded and linked with retailer licensing data to determine the distance between participants’ residence and the nearest retailer (proximity) and the number of retailers within 500-meter and 1-kilometer service areas (density).Results. More than half of the sample lived within 250 meters of a tobacco retailer. A median of 3 retailers were within 500 meters of participants’ residences, and a median of 12 were within 1 kilometer. Among smokers with SMI, tobacco retailer densities were 2-fold greater than for the general population and were associated with poorer mental health, greater nicotine dependence, and lower self-efficacy for quitting.Conclusions. Our findings provide further evidence of the tobacco retail environment as a potential vector contributing to tobacco-related disparities among individuals with SMI and suggest that this group may benefit from progressive environmental protections that restrict tobacco retail licenses and reduce aggressive point-of-sale marketing.Tobacco use among people with serious mental illness (SMI) is common and has serious health and financial costs.1 Nationally, individuals with psychiatric or addictive disorders consume 44% to 46% of cigarettes purchased and are more likely than those in the general population to be daily and heavy smokers.2,3 In one study, it was estimated that smokers with SMI spend, on average, 27% of their income on tobacco.4 Individuals with SMI suffer disproportionately from tobacco-related diseases and, as a group, have a 25-year premature mortality rate.5 Increasingly, researchers and practitioners highlight the need for more targeted prevention and intervention strategies to reduce the burden of smoking-related diseases in this vulnerable group.6,7Cigarette smoking among people with SMI reflects a complex interplay of genetic, neurobiological, cultural, and psychosocial factors.6 Studies have examined shared genetic effects between smoking and SMI,8–11 as well as associations with attention and cognition, stress and mood, and reductions in the side effects of psychotropic medications.6 In addition to individual-level risk factors, a complete understanding of smoking disparities among individuals with SMI requires examination of “upstream” social determinants of health, including social, political, and economic contexts. Accordingly, research on the etiology and maintenance of cigarette use in this disproportionately affected group has increasingly focused on systemic factors outside of an individual’s control, such as tobacco industry targeting, reduced access to smoking cessation services, and tobacco control policies.7,12 Notably, smokers with SMI are responsive to tobacco control policies that have been effective in the general population, such as smoking bans and cigarette tax increases.13–16The built environment is another important social determinant of health that has the potential to affect smoking among people with SMI. In the general population, retail availability of tobacco, which includes the number of retailers per area or population (i.e., density) and the distance to the nearest retailer (i.e., proximity) from one’s home or school, is associated with earlier smoking initiation,17,18 increased current smoking19–22 and cigarette purchases,23 and reduced smoking cessation over time.24,25 Smokers who live in neighborhoods with higher densities of tobacco retailers have greater exposure to retail advertisements and promotions, which can obstruct quit attempts by increasing cues to smoke, provoking cravings, and triggering impulse purchases.26–29 Smokers are price sensitive,30,31 and the financial costs of smoking are lower in communities with more convenient tobacco access and reduced travel time to purchase.22 Moreover, retailers and point-of-sale tobacco advertisements are more prevalent in socially and economically disadvantaged neighborhoods.19,22,32–36The effects of increased tobacco availability may be particularly strong among smokers with SMI given that factors such as unreliable transportation and limited resources37 in this population may lead to a greater reliance on readily obtainable consumer goods. Furthermore, people with SMI have been targeted by the tobacco industry,12,38 and they may be especially sensitive to aggressive tobacco advertisements and promotions. Surprisingly, in spite of the public health relevance, to our knowledge no studies of the retail availability of tobacco have involved clinical samples of individuals with SMI.Our goals in this study, which included a diverse sample of adults with SMI, were to characterize the proximity (roadway distance to the nearest retailer) and density (number of retailers per acre) of tobacco retailers within 500 meters and 1 kilometer of participants’ residences and to assess whether retail availability of tobacco is associated with severity of mental illness, nicotine dependence, and readiness to quit smoking. We also evaluated whether these associations vary according to gender.We hypothesized that smokers with SMI would reside in neighborhoods with greater than average tobacco retailer density for their county area and that this neighborhood characteristic would be associated with greater severity of mental illness. Furthermore, we predicted that increased retail availability of tobacco would be associated with greater nicotine dependence and lower readiness to quit, regardless of severity of mental illness. We also examined gender differences given calls to assess such differences in tobacco control research, policy, and practice39 and recent evidence that proximity to a tobacco retailer is associated with a lower likelihood of smoking cessation among men but not women who are moderate to heavy smokers.24     

e-Cigarette Awareness,Use, and Harm Perceptions in US Adults

Objectives. We estimated e-cigarette (electronic nicotine delivery system) awareness, use, and harm perceptions among US adults.Methods. We drew data from 2 surveys conducted in 2010: a national online study (n = 2649) and the Legacy Longitudinal Smoker Cohort (n = 3658). We used multivariable models to examine e-cigarette awareness, use, and harm perceptions.Results. In the online survey, 40.2% (95% confidence interval [CI] = 37.3, 43.1) had heard of e-cigarettes, with awareness highest among current smokers. Utilization was higher among current smokers (11.4%; 95% CI = 9.3, 14.0) than in the total population (3.4%; 95% CI = 2.6, 4.2), with 2.0% (95% CI = 1.0, 3.8) of former smokers and 0.8% (95% CI = 0.35, 1.7) of never-smokers ever using e-cigarettes. In both surveys, non-Hispanic Whites, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes.Conclusions. Awareness of e-cigarettes is high, and use among current and former smokers is evident. We recommend product regulation and careful surveillance to monitor public health impact and emerging utilization patterns, and to ascertain why, how, and under what conditions e-cigarettes are being used.A heterogeneous collection of battery-driven nicotine inhalers—“e-cigarettes” or electronic nicotine delivery systems (ENDS)—are emerging products receiving considerable advocacy, policy, and media attention.1 ENDS have been marketed as harm-reducing alternatives to smoking and used as cessation aids, though the US Food and Drug Administration (FDA) has not reviewed these claims or devices.2,3 Independent testing of ENDS has demonstrated poor quality control,2,4 low-level toxic contaminants,5 variable nicotine delivery,2,6,7 and insufficient evidence of overall public health benefit.8 Packaging and Web sites for ENDS reveal unsubstantiated health claims and erroneous nicotine content labeling.4 In addition, their wide combination of flavorings and “high-tech” image are potentially attractive to youths and young adults.2,4 In 2010, the World Health Organization recommended that ENDS products be regulated as combination drug and medical devices.1 Consistent with this recommendation, several countries, such as Australia and Canada, restricted or banned ENDS until reviewed by their regulatory agencies.9,10 A 2009 court decision (Sottera Inc v. Food and Drug Administration)11 blocked the FDA from regulating ENDS as drug delivery devices in the United States, ruling that products containing nicotine derived from tobacco are “tobacco products” under the 2009 Family Smoking Prevention and Tobacco Control Act unless they are sold as therapeutic aids for cessation.12 In keeping with this ruling, on April 25, 2011, the FDA announced its intention to regulate ENDS as tobacco products. The nature of the FDA’s ENDS regulation procedure has yet to be determined; until that time, ENDS will likely continue to be sold to consumers without regulation, raising serious concerns for public health.Although variations of ENDS have been on the market since at least 2007,13 little is known about the population prevalence of ENDS use in representative samples. One study examined Google searches and reported a sharp increase from 2008 to 2010 in queries, with ENDS search terms receiving more hits than nicotine patches and snus.14 Although this suggests relative increased interest, the denominators are unknown. In a European study, Etter et al.15 posted a survey in French for 34 days on a cessation Web site (http://www.stop-tabac.ch), which typically obtains about 120 000 visitors a month. Of 214 respondents, 81 eligible ENDS users reported mainly using ENDS for cessation or to avoid disturbing others; some were concerned about potential ENDS toxicity.16 Another online survey17 of first-time ENDS purchasers yielded a response proportion of only 4.5%; considering this low percentage, participants are not likely representative of ENDS purchasers and results are difficult to interpret. In a 2009 Zogby opinion poll, 59% of Americans supported FDA regulation of ENDS, with almost half (47%) saying that ENDS should be made available for people who want to quit smoking.18There are several widely cited and as yet unaddressed concerns regarding the effect of ENDS on public health. First is the concern that ENDS could act as a starter product for combustible cigarettes, especially among youths or young adults who may be attracted to their “tech” image or flavorings.3,19 Other concerns include that ENDS may lure former smokers to return to nicotine dependence, delay cessation among current smokers,2,3 serve as a dual-use product, or enable individuals to avoid smoking restrictions.19 Despite these gaps in our knowledge, there are no reliable national estimates of ENDS awareness, utilization, or harm perceptions in the peer-reviewed literature. Furthermore, other than the 2009 Zogby poll, no investigation of ENDS among nonsmokers is evident.18 This study makes an initial contribution to address some of these pressing knowledge gaps by using cross-sectional data from 2 separate surveys conducted in 2010, 1 nationally representative and 1 from the follow-up of a large cohort of current smokers and recent former smokers, to estimate ENDS awareness, use, and harm perceptions in the adult US population.     

Peer Reviewed: Exploring Use of Nontraditional Tobacco Products Through Focus Groups with Young Adult Smokers, 2002

Introduction

In 2002, 16 focus groups with young adult smokers who used or had tried nontraditional tobacco products (e.g., bidis, shisha, herbal cigarettes, kreteks, cigars, herbal smokeless products) were conducted in Dallas, Texas, and Chattanooga, Tennessee, to gain an understanding of the appeal of these products.

Methods

In each city, groups were segmented by race or ethnicity and by educational status.

Results

Many consistent themes emerged across the groups. Nontraditional tobacco use is not common among young adult smokers. Although some products such as Black & Mild and Swisher Sweets cigars are used frequently by some groups, other products such as shisha, kreteks, and herbal cigarettes are less well known and infrequently used. Among focus group participants, use of nontraditional tobacco products tends to occur in clubs, during social gatherings, or at times when cigarettes are unavailable. More college students than those who were not in college cited cost and inconvenience of purchasing nontraditional tobacco products as reasons for not using them. All focus group participants agreed that African Americans use cigars more than any other racial or ethnic group.

Conclusion

Overall, findings suggest that the reasons for trying nontraditional tobacco products did not differ by race or ethnicity. Family members and peers were mentioned as the source of nontraditional tobacco products when first used. Cost, convenience, taste, smell, and strength were given as reasons both for using these products and for discontinuing their use.     

Perceptions, Barriers, and Suggestions for Creation of a Tobacco and Health Website Among American Indian/Alaska Native College Students

Information concerning American Indian/Alaska Native (AI/AN) Internet use and health information needs is dearth. Our research team explored Internet use among AI/AN college students to determine Internet use in relation to health information seeking behaviors. We used a tobacco site example for participants to describe what they desired in a health site designed specifically for AI/AN. Using a community-based participatory research approach, we conducted 14 focus groups with AI/AN college students (N = 108), to better understand their perceptions of and attitudes toward Internet use and health information needs. Daily Internet use was reported across strata yet health topics investigated differed among groups. Participants in all strata desired a health website that was easy to navigate and interactive. Respectful representation of Native culture was a concern, yet no consensus was reached for a multi-tribal audience. Participants felt a website should use caution with cultural depictions due to the possible misinterpretation. Overall, participants agreed that recreational and traditional tobacco use should be differentiated and the variation of traditional use among tribes acknowledged. Data concerning Internet use for health information among AI/AN college students are needed to establish baseline indicators to effectively address disparities.     

Prevalence and Sociobehavioral Correlates of Tobacco Use Among Hispanic Children: The Tobacco Resistance Activity Program

ABSTRACT: To examine tobacco use patterns and its sociobehavioral correlates among Hispanic in-school youth, a tobacco use and knowledge survey was administered to 660 children from fourth through sixth grade classes, of which 69% (n = 453) were of Hispanic origin. Male Hispanics were more exposed to previous tobacco use (38% vs. 20%, p < .01), reported more current smoking, had more smoking friends, received more cigarette offers, and wanted to try a cigarette compared to females (all p < .05). Also, more previous alcohol use was noted in the previous tobacco users, indicating its potential as a "gateway drug." From multivariate analyses, being offered cigarettes was the strongest environmental indicator of previous tobacco usage, followed by having adult smokers in the house, smoking friends, (all p < .01), and being around other smoking youth (p < .05). This study offers additional knowledge about factors that may cause Hispanic youth to initiate smoking, and suggests the need to address peer and social influences in school-based substance abuse programs. (J Sch Health. 1993;63(9):391–396)     

Prevalence and Predictors of Tobacco Use Among Lumbee Indian Women in Robeson County, North Carolina

Tobacco use among some Native American tribes is high compared to the overall US population. Little is known, however, about tobacco use among Native Americans in North Carolina, a state with strong economic ties to tobacco. To assess the epidemiology of tobacco use in this population, data from the North Carolina Native American Cervical Cancer Project was reviewed. Nine hundred eighty-two Lumbee Indian women in Robeson County provided general demographic information as well as information on cancer risk knowledge, attitudes and behaviors during the 5-year study. Women were selected from the community using a random sample of 5200 persons from the tribal roll of approximately 40,000 persons. 20.6% of women were current smokeless tobacco users, while 23.7% were current smokers. Demographic and social support predictors were unique for the different types of tobacco use. Cigarette smoking was associated with younger age, higher education, excellent or good self-reported health, having a recent physical exam, separated or divorced marital status, low church participation, and alcohol consumption. Conversely, use of smokeless tobacco was associated with older age, lower education level, fair or poor self-reported health, widowed marital status, and having a high number of friends. These data show a high prevalence of smokeless tobacco use among women in this population, and a contrast in the predictors of tobacco use by source. Intervention programs for tobacco use cessation should be sensitive to these differences.     

Perceptions and Experiences of Vaping Among Youth and Young Adult E-Cigarette Users: Considering Age,Gender, and Tobacco Use

PurposeThis study examined differences in the topics of vaping perceptions (positive and negative aspects) and experiences (social media content) among e-cigarette users segmented by age and gender (male and female youth and young adults) and tobacco use (never, former, or current user).MethodE-cigarette users (N = 558, 53.6% male, mean age: 18.6 years [SD = 2.2], mean use: 5.3 days/week [SD = 2.3]) residing in Nova Scotia, Canada, responded to three open-ended topic questions concerning vaping in an online survey. Responses to each topic (e.g., positive aspects) were coded and grouped into categories (e.g., flavors). Chi-square tests were used to examine whether groups differed by topic, and Bonferroni correction tests were used to determine specific group differences in each coded category.ResultsAge and gender groups differed in their positive perceptions of a nicotine rush, tricks, and positive social aspects of vaping and in their negative perceptions of respiratory effects, nicotine effects, product malfunction and cost, and negative social aspects of vaping. Age and gender groups also differed in exposure to tricks and branding on social media. Tobacco use groups differed in their positive perceptions of flavor, nicotine rush, tricks, low cost, enhancement, and smoking cessation and in their negative perceptions of negative social aspects and exposure to tricks on social media.ConclusionsThere are notable similarities and differences among youth and young adult e-cigarette users by age, gender, and tobacco use. Policies and interventions should incorporate these distinctions to effectively address the increasing use of e-cigarettes among young users.