Pilot study to inform young adults about the risks of electronic cigarettes through text messaging.

INTRODUCTION: Young adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings. METHODS: A two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure. RESULTS: Participants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02). CONCLUSIONS: This was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.

Validation of mobile phone text messages for nicotine and tobacco risk communication among college students: A content analysis.

INTRODUCTION: In the United States, young adults have the highest prevalence of tobacco use. The dissemination of mobile phone text messages is a growing strategy for tobacco risk communication among young adults. However, little has been done concerning the design and validation of such text messages. The Texas Tobacco Center of Regulatory Science (Texas-TCORS) has developed a library of messages based on framing (gain- or loss-framed), depth (simple or complex) and appeal (emotional or rational). This study validated the library based on depth and appeal, identified text messages that may need improvement, and explored new themes. METHODS: The library formed the study sample (N=976 messages). The Linguistic Inquiry and Word Count (LIWC) software of 2015 was used to code for word count, word length and frequency of emotional and cognitive words. Analyses of variance, logistic regression and scatter plots were conducted for validation. RESULTS: In all, 874 messages agreed with LIWC-coding. Several messages did not agree with LIWC. Ten messages designed to be complex indicated simplicity, while 51 messages designed to be rational exhibited no cognitive words. New relevant themes were identified, such as health (e.g. 'diagnosis', 'cancer'), death (e.g. 'dead', 'lethal') and social connotations (e.g. 'parents', 'friends'). CONCLUSIONS: Nicotine and tobacco researchers can safely use, for young adults, messages from the Texas-TCORS library to convey information in the intended style. Future work may expand upon the new themes. Findings will be utilized to develop new campaigns, so that risks of nicotine and tobacco products can be widely disseminated.

Development and initial testing of the brief adolescent smoking curiosity scale (ASCOS).

BACKGROUND: Although the reasons behind tobacco smoking at young age are complex, research has identified curiosity as a potent driver of smoking among adolescents. OBJECTIVE: The objective of the current study is to develop and provide initial evidence of reliability and validity of a short scale assessing smoking curiosity among adolescents (first measure of its kind). In particular, we developed and tested the adolescent smoking curiosity scale (ASCOS). METHODS: After scale development, 101 adolescents completed a survey on smoking-related measures, including ASCOS (June to August 2014). We conducted exploratory factor analysis and Cronbach's alpha calculation to inspect factor-structure and reliability. We conducted multiple linear regression models to examine the scale's capacity to predict antecedents of smoking initiation. RESULTS: Factor analysis supported a single-factor structure of smoking curiosity. ASCOS was internally reliable (Cronbach's alpha=0.83). Controlling for demographics, the measure correlated significantly with temptation to try smoking (ß=0.41, p<0.01), number of friends who smoke (ß=0.27, p<0.01), agreeing with the pros of smoking (ß=0.41, p<0.001), sensation seeking (ß=0.21, p<0.05), and depression (ß=0.23, p<0.01). When controlling for a single-item measure for smoking curiosity, ASCOS significantly predicted susceptibility to smoke cigarettes (OR=3.40, p<0.05) and cigars (OR=6.66, p<0.01). CONCLUSIONS: ASCOS presented good psychometric properties and passed initial validity-testing through associations with antecedents of smoking. ASCOS was a better predictor of susceptibility to smoke than did a traditional single-item measure used by previous research. As an implication, ASCOS can be crucial to the development of tailored interventions for smoking prevention that can reduce smoking curiosity.

A Pilot Study for Linking Adolescent Patients to an Interactive Tobacco Prevention Program.

CONTEXT: The American Academy of Pediatrics and professional guidelines recommend intervening with adolescents about avoiding tobacco use in the health-care setting. Barriers in the clinical setting limit consistent provision of this critical service. OBJECTIVES: This pilot study compared 2 approaches for referring adolescents to an evidence-based tobacco prevention and cessation program in the outpatient setting. Secondary aims assessed tobacco use, knowledge, and program evaluation. DESIGN SETTING AND PARTICIPANTS: The study setting was a medical and dental clinic. Participants aged 13 to 18 received tobacco advice and instructions to work through "A Smoking Prevention Interactive Experience." The program addresses health concerns of adolescents about tobacco use and is founded on behavioral change theories. The link to access it is featured on the website of the National Cancer Institute's Research-Tested Interventions. Participants (N = 197) were randomized to 1 of 2 approaches (ie, a program link via e-mail or referral by a printed card). RESULTS: The program was accessed by 57% (112 of 197) of participants. Both referral approaches were equally effective. Non-Hispanics were twice as likely to access the program as Hispanics (adjusted odds ratio = 2.1, 95% confidence interval = 1.2-3.8, P < .05). Over 95% of participants identified themselves as nonusers of tobacco and evaluated the program as beneficial in increasing knowledge and motivation to remain tobacco-free. CONCLUSION: Linking adolescent patients to an evidence-based tobacco prevention/cessation program at a community health clinic was highly promising and feasible. We present conclusions for future research.

Developing mobile phone text messages for tobacco risk communication among college students: a mixed methods study.

BACKGROUND: Engaging young adults for the purpose of communicating health risks associated with nicotine and tobacco use can be challenging since they comprise a population heavily targeted with appealing marketing by the evolving tobacco industry. The Food and Drug Administration seeks novel ways to effectively communicate risks to warn about using these products. This paper describes the first step in developing a text messaging program delivered by smartphones that manipulate three messaging characteristics (i.e., depth, framing, and appeal). METHODS: Perceptions of community college students were described after previewing text messages designed to inform about risks of using conventional and new tobacco products. Thirty-one tobacco users and nonusers, aged 18-25 participated in five focus discussions held on two community college campuses. Attendees reviewed prototype messages and contributed feedback about text message structure and content. Qualitative data were coded and analyzed using NVivo Version 10. RESULTS: Most participants were female and two-thirds were ethnic minorities. A variety of conventional and new tobacco products in the past month were used by a third of participants. Three identified domains were derived from the qualitative data. These included perceived risks of using tobacco products, receptivity to message content, and logistical feedback regarding the future message campaign. CONCLUSION: Overall, participants found the messages to be interesting and appropriate. A gap in awareness of the risks of using new tobacco products was revealed. Feedback on the prototype messages was incorporated into message revisions. These findings provided preliminary confirmation that the forthcoming messaging program will be appealing to young adults.

Nicotine and Tobacco Use Prevention among Youth and Families.

OBJECTIVE: To review the importance of and evidence-based strategies to prevent tobacco use and promote tobacco cessation in the pediatric setting. DATA SOURCES: Literature review of evidence-based resources on tobacco use and prevention/cessation interventions in the pediatric/adolescent population. CONCLUSION: Knowledge of the impact of tobacco use on cancer risk, second- and third-hand smoke carcinogenesis, and newer methods of tobacco delivery is necessary to select appropriate and effective prevention and cessation strategies. IMPLICATIONS FOR NURSING PRACTICE: Systematic evaluation of both parents and children for tobacco use can identify patients that will benefit from tobacco cessation interventions. Patients and families need education and support so they can make good decisions and adhere to recommendations for prevention and cessation of tobacco use.

Respiratory Symptoms After Smoking Cessation among College Students.

Data on respiratory symptoms after smoking cessation are available for mature adults, but for young adults these data are limited to observational studies. This retrospective analysis of smoking cessation trials addresses the gap. A cohort of 18- to 24-year-olds without chronic respiratory illness was developed from 2 randomized trials of behavioral interventions versus standard care to promote smoking cessation. This secondary analysis was performed to determine whether short-term respiratory health improvements occurred among those who achieved smoking cessation for 2 weeks or more. Self-reported respiratory symptoms were assessed at baseline and last follow-up. The sample numbered 327, 60% smoked 5-10 cigarettes a day and 56% smoked for 1-5 years. Abstinence periods among those achieving cessation ranged from 2 to 78 weeks. The mean overall baseline respiratory symptom score was 14.3, standard deviation (SD)=11.5. Respiratory symptoms for those achieving cessation were mean=13.3, SD=11.2, decreasing to mean=3.8, SD=5.9 symptom days at the last follow-up. Baseline symptoms for those who continued smoking were mean=14.6, SD=11.6, decreasing to mean=10.3, SD=10.3 at follow-up. Five fewer respiratory symptom days per week were noted for those who stopped smoking (mean=5.2, SD=1.5, P<0.0001). Smoking cessation is associated with reduced respiratory symptoms. Feedback of short-term health consequences may be relevant to younger populations who may perceive smoking hazards as in the distant future.