Understanding college students' experiences using e-cigarettes and marijuana through qualitative interviews.

OBJECTIVE: To investigate the contexts in which college students use e-cigarettes and marijuana, perceptions about the benefits and harms, and health effects of use. PARTICIPANTS: College student e-cigarette and marijuana ever users (n = 20; 18-21 years old) from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS). METHODS: Participants completed a one-hour long online interview about their experiences using e-cigarettes and marijuana. Thematic content analysis in NVivo identified prominent themes. RESULTS: Vaping nicotine and marijuana were preferred and perceived as normal, trendy and useful in circumventing smoke-free campus policies. Preference for nicotine versus marijuana fluctuates during the academic school year in response to campus restrictions and work and school-related activities. College students commonly experienced health effects (shortness of breath, wheezing) attributed to vaping, did not perceive their use as very harmful, and perceived their use as a college-related phase. CONCLUSIONS: Findings have implications for college-based health education, resources, and smoke-free policies.

Health-related quality of life and social determinants of health following COVID-19 infection in a predominantly Latino population.

BACKGROUND: As the COVID-19 pandemic evolves, more information is needed on its long-term impacts on health-related quality of life (HRQoL) and social determinants of health (SDoH). The aim of the study was to assess HRQoL and SDoH among a predominantly Latino population of COVID-19 survivors and to compare effects in Latinos versus non-Latinos. METHODS: This cross-sectional study consisted of a survey (in English and Spanish) of COVID-19 survivors from December 2020 to July 2021. The study assessed sociodemographic data, clinical characteristics, and SDoH, consisting of 10 COVID-19-related concerns. The PROMIS-29 + 2 (PROPr) measure, which captures 8 HRQoL domains and a preference-based health utility, was used to assess HRQoL. Bivariate analyses included chi-square tests and t-tests. Generalized linear models were conducted for multivariable analyses. RESULTS: Of 230 respondents (6.3% response rate), the mean [SD] age was 43.1 [14.3] years; 83.0% were Latino; the mean [SD] time since diagnosis was 8.1 [3.2] months; and 12.6% had a history of hospitalization with COVID-19. HRQoL scores were slightly worse than population norms on all domains, especially anxiety; the mean [SD] PROPr health utility was 0.36 [0.25]. Domain scores were similar by ethnicity except for cognitive function-abilities, where scores were lower in Latinos. Multivariable analyses revealed that: (1) financial concerns were associated with worse health utility, as well as worse scores on all 8 PROMIS domains; (2) interpersonal conflict was associated with worse health utility and worse scores on 6 of the 8 PROMIS domains (anxiety, depression, fatigue, sleep disturbance, social function, and pain interference); and (3) Latino ethnicity was only associated with 1 PROMIS domain (cognitive function-abilities) after controlling for covariates. CONCLUSION: COVID-19 infection is associated with HRQoL decrements long after the acute infection, and financial concerns and interpersonal conflict are particularly associated with worse HRQoL.

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. Supplementary Information: The online version contains supplementary material available at 10.1007/s40429-022-00413-y.

Risk of respiratory, gastrointestinal, and constitutional health symptoms: A cross-sectional study of Texas adolescent and young adult nicotine and marijuana vapers.

Observational studies investigating the health consequences of vaping among youth and young adults are limited. This study aimed to describe and examine the risk for health symptoms by vape user category (never users, marijuana only, nicotine only, and dual users). Health symptoms included adverse respiratory, gastrointestinal, and constitutional problems. This cross-sectional study analyzed data from Fall 2020, Wave 12 (n = 2389) of the Texas Adolescent Tobacco and Marketing Surveillance System. Chi-square, one-way analysis of variance (ANOVA), and multivariable logistic regression analyses examined the associations between past 30-day vape user category and 15 health symptoms (e.g., coughing, nausea, vomiting, fever). For total symptoms, dual vapers reported the highest mean (2.76[standard deviation = 3.17]), followed by nicotine-only vapers (2.47[2.89]), marijuana-only vapers (1.94[2.60]), and never users (1.56[2.31]), p < .001. Dual vapers and nicotine-only vapers had significantly higher odds of experiencing respiratory symptoms as compared with never users (adjusted odds ratios [AORs] = 2.35, 95% confidence interval [CI]: 1.30, 4.25; AOR = 1.86, 95% CI: 1.22, 2.81, respectively). Marijuana-only (AOR = 2.41, 95% CI: 1.53, 3.79), nicotine-only (AOR = 2.03, 95% CI: 1.38, 2.99), and dual vapers (AOR = 2.03, 95% CI: 1.15, 3.57) had significantly higher odds of gastrointestinal symptoms compared with never users. Dual vapers had significantly higher odds of experiencing constitutional symptoms as compared to never users (AOR = 1.92, 95% CI: 1.10, 3.34). This study uniquely highlights the risk for gastrointestinal symptoms from vaping. Future research and clinical practice should monitor the occurrence of these symptoms and explore potential mechanisms, such as specific flavorings or chemicals, for the link between vaping and health symptoms.

Changes in marijuana and nicotine vaping perceptions and use behaviors among young adults since the COVID-19 pandemic: A qualitative study.

BACKGROUND: Research is lacking on the impact of the COVID-19 pandemic on marijuana vaping behaviors; a notable limitation as marijuana vaping has been previously associated with respiratory issues among young people. This qualitative study explored how the COVID-19 pandemic influenced vaping perceptions and behaviors among young adults (18 to 25-year-olds). METHODS: Qualitative interviews were conducted with 50 regular marijuana vapers. Individuals were eligible if they vaped marijuana at least 3 days per week (exclusively or dual use with nicotine). Interview transcripts were analyzed using deductive coding processes to identify themes. Differences in themes by gender and user status (regular marijuana versus regular dual vapers) were explored. RESULTS: While many participants indicated that the pandemic negatively impacted their attitudes about vaping, participants also noted that their negative attitudes did not translate into reductions in use. Overall, 54% of participants reported increasing vaping during COVID-19. For both regular dual vapers and marijuana vapers, boredom was a prominent theme for increases in vaping. Lack of accessibility of marijuana was cited as a reason for decreasing marijuana among regular marijuana vapers but not for regular dual vapers. Males reported more unchanged attitudes about vaping and more males than females reported still sharing their devices. CONCLUSIONS: More than half of participants reported increasing their vaping behaviors since the COVID-19 pandemic despite concerns about the potential for vaping to adversely impact lung and immune health. As the U.S. adapts to the COVID-19 pandemic, interventions should address factors that may contribute to increases in use behaviors.

Use frequency and symptoms of nicotine dependence among adolescent E-cigarette users: Comparison of JUUL and Non-JUUL users.

OBJECTIVE: Nicotine exposure among adolescent e-cigarette users remains a public health concern. JUUL, a popular e-cigarette brand among youth, is particularly alarming given the high nicotine delivery (59 mg/mL). This study compares e-cigarette use frequency and symptoms of nicotine dependence among adolescent JUUL and non-JUUL users. METHODS: We analyzed data from the 2020 National Youth Tobacco Survey. Participants were n = 1713 U.S. middle and high school students who reported past 30-day e-cigarette use. We compared adolescent e-cigarette users who reported JUUL use to those who did not. Outcomes were: (1) symptoms of nicotine dependence (i.e. nicotine cravings; use within 30 min of waking); (2) past 30-day e-cigarette use frequency, categorized as 1-5 days, 6-19 days, and 20-30 days. Covariates were sex, race/ethnicity, other tobacco product use, primary e-cigarette device type (i.e., disposable; pod; mod/tank). RESULTS: Overall, 49.5% of adolescent e-cigarette users reported using JUUL in the past 30 days, 40.1% reported symptoms of nicotine dependence, and 36.2% reported using an e-cigarette on 20-30 days. JUUL users were 1.77 (95% CI: 1.36-2.31) times as likely to report symptoms of nicotine dependence and 1.43 (95% CI: 1.02-2.01) time as likely to report using e-cigarettes on 20-30 days, compared to 1-5 days, relative to non-JUUL users, controlling for covariates. CONCLUSION: JUUL use was associated with greater odds of nicotine dependence and more frequent e-cigarette use among adolescents. Greater prevention and regulatory efforts should be made to prevent adolescent use of high dose nicotine devices such as JUUL.

Subjective experiences at e-cigarette initiation: Implications for e-cigarette and dual/poly tobacco use among youth.

BACKGROUND: Subjective experiences (SEs) at initiation of cigarettes, cigars, and smokeless tobacco have been established as predictors of continued use. To date, less is known about the relationships between SEs at e-cigarette initiation and subsequent e-cigarette use behaviors. METHODS: This study used data from Waves 1-6 of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system; a population-based rapid response study of adolescents in major metropolitan areas of Texas. Participants were adolescents who self-reported ever using e-cigarettes across all 6 waves (n = 1,104; N = 460,069). Factor analyses examined structure of SEs at e-cigarette initiation. Weighted, multilevel, multivariate regression models examined role of SEs at e-cigarette initiation on subsequent past 30-day e-cigarette use behaviors. RESULTS: Factor analyses identified a positive (i.e., euphoria, relaxation) and a negative (i.e., dizziness, cough, nausea) domain of SEs. Positive SEs at e-cigarette initiation predicted 1.20 (95% CI: 1.02-1.42) greater odds of subsequent past 30-day e-cigarette use. Similarly, positive SEs at e-cigarette initiation predicted greater relative risk of dual/poly e-cigarette use, relative to non-use (RRR: 1.61; 95% CI: 1.24-2.10) and exclusive e-cigarette use (RRR: 1.68; 95% CI: 1.26-2.24). CONCLUSION: This is the first study to observe longitudinal relationships between SEs at e-cigarette initiation and subsequent e-cigarette use behaviors. Findings highlight the importance of preventing initial e-cigarette use among adolescents.

Longitudinal trajectories of E-cigarette use among adolescents: A 5-year, multiple cohort study of vaping with and without marijuana.

E-cigarette use harms adolescent health, yet it continues to escalate rapidly among teens nationwide. This longitudinal study sought to identify and differentiate between developmental trajectories of past 30-day e-cigarette use with and without marijuana (i.e., liquid THC) across adolescence (11-19 years old). Three population-based cohorts of adolescents (n = 3907; N = 461,069) living in major metropolitan areas of Texas (Houston, Dallas-Ft. Worth, San Antonio, Austin) completed up to 9 Waves of an e-cigarette use survey, from 2014 to 2019. Growth curve models (GCMs) were used to identify average trajectories of past 30-day e-cigarette use, by cohort. Growth mixture models (GMMs) were used to investigate developmental patterns in these trajectories, by cohort. Sociodemographic differences in trajectories were also investigated. Stable trajectories of e-cigarette use with and without marijuana were identified, from 11 through 19 years of age. Trajectories varied by age of onset; frequency and escalation in use; and substance used. With one exception, all trajectories of e-cigarette use escalated with age. Moreover, age of onset and progression in use were positively related. The most problematic trajectories, corresponding to more frequent use, were observed among the younger cohorts compared to the oldest. Primary prevention is critical. Interventions to prevent the onset and progression in e-cigarette use among teens must begin early (e.g., in middle school) and be sustained throughout adolescence.

Emotional symptoms and sensation seeking: Implications for tobacco interventions for youth and young adults.

INTRODUCTION: Although emotional symptoms and sensation seeking are recognized as important risk factors for tobacco use among youth and young adults, to date, their joint influence on tobacco use has not been examined. METHODS: Data used in this study are from the Texas Adolescent Tobacco and Marketing Surveillance study, a population-based cohort. At baseline, in 2014, participants were in the 10th grade. Mixed-effects logistic regression models examined associations between emotional symptoms and sensation seeking in 2014 and odds of past 30-day cigarette and e-cigarette use in 2018. Interactions between emotional symptoms and sensation seeking were examined to assess whether one modifies the effect of the other on cigarette and e-cigarette use. RESULTS: After adjusting for age, sex, race/ethnicity, school type, and ever use of cigarettes or e-cigarettes at baseline, adolescents with high emotional symptoms (AORcig=1.97; 95% CI:1.07-3.60, and AORe-cig=1.68; 95% CI: 1.06-2.66) and with high sensation seeking tendencies (AORcig=2.05; 95% CI: 1.03-4.10, and AORe-cig=1.68; 95% CI: 1.02-2.76) had significantly higher odds of past 30-day cigarette and e-cigarette use four years later compared to adolescents with low emotional symptoms and low sensation seeking tendencies. The interaction was significant (p=0.01) for e-cigarette use only; among low sensation seekers, adolescents who reported high levels of emotional symptoms were at increased risk for past 30-day use (AORe-cig=3.43; 95% CI: 1.38-8.51), and among adolescents with low emotional symptoms, high sensation seekers were at increased for risk for past 30-day use (AORe-cig=3.50; 95% CI: 1.54-7.91). CONCLUSIONS: It is important for tobacco use prevention programs to consider both behavioral risk factors - sensation seeking and emotional symptoms - in an integrative way, to target high risk subgroups and thereby increase the efficacy of existing effective intervention strategies in order to curb tobacco use among youth and young adults.

Comparing Risk Factors for Past 30-day E-cigarette and Combustible Tobacco Use: A Longitudinal Analysis of the Texas Adolescent Tobacco and Marketing Surveillance Study (2014-2017).

Significance: Youth use of e-cigarettes is reaching 'epidemic proportions,' even as combustible tobacco use is declining. Comparison of risk factors that are uniquely associated with e-cigarette and combustible tobacco use among adolescents is warranted. Methods: Six waves of data from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) study (n=3907; N=461,069; 2014-2017) were used in this analysis. A random intercept logistic regression model was used to compare intrapersonal, interpersonal, and environmental risk factors for use of both products based on the Social Ecological Model. Results: Risk factors that were significantly associated with both past 30-day use of e-cigarette and combustible tobacco products over time included past 30-day use of marijuana and alcohol, social acceptability of product use, having friends and family members who used the products, and male gender. Increasing age, worse academic performance, higher sensation seeking score, higher recall of social media promotion in the past 30 days, and lower positive affect score were associated with past 30-day use of combustible tobacco only. White race was associated with past-30 day use of e-cigarettes only. Conclusion: Involving peers and parents in preventive interventions designed to reduce uptake of these products is paramount, as is the need to address other substance use, like alcohol and marijuana. Efforts should also be made to create a social climate that makes tobacco use (e-cigarettes and combustible products) less acceptable and desirable.

Development of an E-Cigarettes Education and Cessation Program: A South Texas Oral Health Network Study.

Electronic cigarette (e-cigarette) use, or vaping, among youth and young adults has become a major public health concern. The prevalence of vaping has grown an astounding 900% among high school students from 2011 to 2015, and e-cigarette use among high school students has increased by 78% from 2017 to 2018, largely due to the rise in popularity of the high-dose nicotine product, JUUL. To date, there are few evidence-based e-cigarette cessation programs. To address this need, the South Texas Oral Health Network collaborated with dental practitioners and community members to conduct focus groups assessing knowledge and awareness of e-cigarette use. Based on this feedback, we developed a dental practitioner-based e-cigarette cessation program. The next step will be to utilize this program in a practice-based research network, a "real-world" practice setting that has the potential to increase the number of dental practitioners who counsel their patients about ecigarettes.

Stress, Dependence, and COVID-19-related Changes in Past 30-day Marijuana, Electronic Cigarette, and Cigarette Use among Youth and Young Adults.

BACKGROUND: Studies show smoking and vaping behaviors increase risk of contracting and worse symptoms of COVID-19. This study examines whether past 30-day youth and young adult users of marijuana, e-cigarettes, and cigarettes self-reported changes in their use of these substances due to the COVID-19 pandemic; and cross-sectional associations between perceived stress, nicotine or marijuana dependence, and COVID-19-related changes in use. METHODS: Participants were 709 past 30-day self-reported substance users from the Texas Adolescent Tobacco and Marketing Surveillance study (TATAMS; mean age = 19; 58% female; 38% Hispanic, 35% white). Multiple logistic regression models assessed cross-sectional associations between perceived stress and dependence and increased, decreased, or sustained past 30-day use of marijuana, e-cigarettes, and cigarettes due to COVID-19 (e.g., "Has your marijuana use changed due to the COVID-19 outbreak?"). Covariates included age, race/ethnicity, socio-economic status (SES), dependence (exposure: stress), and stress (exposure: dependence). RESULTS: Most participants reported sustained (41%, 43%, 49%) or increased (37%, 34%, 25%) use of marijuana, e-cigarettes, and cigarettes due to COVID-19, respectively. Participants who reported symptoms of dependence were significantly more likely than their non-dependent peers to report increasing their marijuana (AOR: 1.66; 95% CI: 1.15-2.39) and e-cigarette (AOR: 2.57; 95% CI: 1.38-4.77) use. Those who reported higher perceived stress were significantly more likely to report increasing their marijuana use (AOR: 1.55; 95% CI: 1.01-2.42). CONCLUSIONS: Most youth and young adults did not decrease their substance use amid a global, respiratory disease pandemic. Health messaging and interventions that address the health effects of smoking and vaping as well as factors like stress and dependence that may be barriers to decreasing use are vital in curbing the COVID-19 pandemic.

Predictors of JUUL, other electronic nicotine delivery systems, and combustible tobacco initiation among Texas youth.

The objectives of this study were to 1) examine longitudinal predictors of JUUL and other tobacco product initiation, 2) compare these predictors across product type, and 3) describe cross-sectional characteristics of JUUL initiators, among a cohort of Texas adolescents. Analyses were also stratified to examine whether predictors of initiation differed by susceptibility to tobacco use at baseline. This study utilized data from Waves 7 and 8 (Fall 2017 and Spring 2018) of the Texas Adolescent Tobacco and Marketing Surveillance System (n = 2272). Chi-square tests and multinomial logistic regressions were conducted to examine differences in predictors of initiation. Among those who initiated at Wave 8 (n=107), 40.2% initiated JUUL, 43.9% initiated other ENDS, and 15.9% initiated other combustible tobacco. For the full sample, ever marijuana use predicted the initiation of all tobacco products (Relative Risk Ratios "RRRs" from 2.31-4.13) as compared to non-users. For non-susceptible youth, ever marijuana use significantly predicted the initiation of JUUL (RRR = 10.08, 95% CI = 2.11-48.17) and other ENDS use (RRR = 12.07, 95% CI = 2.97-49.04). Peer tobacco use predicted the initiation of JUUL (RRR = 3.06, 95% CI = 1.38-6.81) and other ENDS use (RRR = 5.36, 95% CI = 2.11-13.64) for the full sample, as well as those who were susceptible to tobacco use. For non-susceptible youth, peer tobacco use predicted the initiation of combustible tobacco use (RRR = 16.56, 95% CI = 1.56-175.84). Prominent reasons for JUUL use included curiosity, friend use, and less harmful that cigarettes. Results highlight the role of marijuana in the initiation of all tobacco products, even among low-risk youth; other predictors varied between product type. Interventions should address specific predictors to prevent youth from transitioning to tobacco use.

The influence of neuroticism in terms of E-cigarette dependence and beliefs about use and quitting among dual users of combustible and electronic cigarettes.

OBJECTIVE: Dual use of combustible and electronic cigarettes (e-cigarettes) is increasing in prevalence and may be related to an increased risk for health problems. Accordingly, dual users represent a particularly vulnerable group. Neuroticism is an individual difference factor that demonstrates robust relations to combustible cigarette use. Yet, no work has examined neuroticism in relation to e-cigarette dependence or cognitions among dual users. METHODS: To address this limitation, the present study examined neuroticism in relation to e-cigarette dependence, expectancies about the negative effects of e-cigarettes, and perceived barriers for quitting e-cigarettes. The present study analyzed data collected from a cross-sectional survey of 437 dual combustible cigarette and e-cigarette users (49.9% female, Mage = 35.12 years, SD = 10.04). RESULTS: Results indicated that neuroticism was significantly, positively related to e-cigarette dependence (ΔR2 = 0.02, p < .001), expectancies about the negative effects of e-cigarettes (ΔR2 = 0.03, p < .001), and perceived barriers for quitting e-cigarettes (ΔR2 = 0.10, p < .001). CONCLUSIONS: These novel findings suggest there may be merit in further exploring the role of neuroticism in the maintenance of concurrent combustible cigarette and e-cigarette use.

A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of "CATCH My Breath".

OBJECTIVES: From 2017 to 2018, electronic cigarette (e-cigarette) use increased 78% among high school students and 48% among middle school students in the United States. However, few e-cigarette prevention interventions have been evaluated. We determined the feasibility and initial effectiveness of "CATCH My Breath," an e-cigarette prevention program, among a sample of middle schools in central Texas. METHODS: Twelve middle schools in Texas (6 intervention schools and 6 control schools) participated in the CATCH My Breath pilot program during 2016-2017. CATCH My Breath is rooted in social cognitive theory, consists of 4 interactive in-class modules, and is collaboratively administered via classroom and physical education teachers, student-peer leaders, and social messaging (eg, school posters). We collected 3 waves of data: baseline (January 2017), 4-month follow-up (May 2017), and 16-month follow-up (May 2018). Using school as the unit of analysis, we tested a repeated cross-sectional, condition-by-time interaction on e-cigarette ever use, psychosocial determinants of use, and other tobacco use behaviors. Analyses controlled for school-level sociodemographic characteristics (eg, sex, race/ethnicity, and percentage of students eligible for free or reduced-price lunch). RESULTS: From baseline to 16-month follow-up, increases in ever e-cigarette use prevalence were significantly lower among intervention schools (2.8%-4.9%) than among control schools (2.7%-8.9%), controlling for covariates (P = .01). Intervention schools also had significantly greater improvements in e-cigarette knowledge (ß = 0.71; 95% confidence interval [CI], 0.21-1.21; P = .008) and perceived positive outcomes (ß = -0.12; 95% CI, -0.23 to -0.02; P = .02) than control schools, controlling for covariates from baseline to 16-month follow-up. CONCLUSION: Ever e-cigarette use was lower among middle schools that implemented the CATCH My Breath program than among those that did not. Replication of findings among a larger sample of schools, using a group-randomized, longitudinal study design and a longer follow-up period, is needed.

Who is JUULing and Why? An Examination of Young Adult Electronic Nicotine Delivery Systems Users.

PURPOSE: The purpose of this study was to compare characteristics of usual JUUL users versus other electronic nicotine delivery systems (ENDS) users, examine differences in reasons for use and perceptions across ENDS user groups, and identify significant correlates of usual JUUL use. METHODS: This study used data from 510 young adult ENDS users (ages 18-29 years) from Wave 7 (Spring 2018) of the Marketing and Promotions Across Colleges in Texas Project (Project M-PACT). Chi-Square analyses, independent t-tests, and mixed-effects logistic regression analyses were conducted to identify factors associated with usual JUUL use. Four separate regression analyses were conducted based on independent variables of interest; all models included demographics and ENDS/other tobacco use behaviors as covariates. RESULTS: Compared with other ENDS users, usual JUUL users were more likely to be male, younger, smoke cigarettes, reported a higher socioeconomic status (SES), used ENDS on more days in the past 30 days, and reported nicotine "hit" as a reason for use. Usual JUUL users had a higher prevalence of perceiving JUUL/pod vapes as addictive compared with other ENDS users, although perceived addictiveness was not significant in the multivariable models nor were the cessation and dependence measures different between ENDS user groups. CONCLUSIONS: Results highlight concerns about the dual use of JUUL and cigarettes and raise additional concerns about the high nicotine concentration of JUUL. Future longitudinal research is needed to determine if usual JUUL users are more likely to develop symptoms of nicotine dependence compared with other ENDS users.

Characterizing ENDS use in young adults with ecological momentary assessment: Results from a pilot study.

INTRODUCTION: Ecological Momentary Assessment (EMA) allows for assessment of electronic nicotine delivery systems (ENDS) use in real-time. This EMA study aimed to 1) describe study participation rates; 2) evaluate the concordance of EMA and survey items measuring frequency and quantity of ENDS use; and 3) assess the relationships between EMA items measuring frequency and quantity of ENDS use with ENDS dependence, measured at baseline and with saliva cotinine collected at follow-up. METHODS: Fifty young adult ENDS users completed baseline surveys, EMAs (i.e., random, event-based, daily diaries), and follow-up questionnaires over a 14-day period. Spearman correlations were conducted to determine concordance of survey items. Linear regression models assessed the relationships between EMA ENDS use characteristics (e.g., puffs, number of days used, quantity of e-liquid) with dependence items at baseline and saliva cotinine at follow-up. RESULTS: Overall completion for the prompted EMAs (random and daily diaries) was 68%. Correlations between EMA measures assessing ENDS use ranged from weak (ρ = -0.02; NS) to strong (ρ = 0.69, p < .001); EMA to follow-up items ranged from weak (ρ = 0.16; p < .05) to moderate (ρ = 0.54; p < .001). Significant associations were found between ENDS use measured via random and daily diary EMAs and saliva cotinine at follow-up after controlling for cigarette smoking (B = 0.70-1.76; p < .01), but not for event-based EMAs. Items measuring frequency/quantity of use from random EMAs were consistently associated with ENDS dependence at baseline (B = 0.74-1.58; p < .01). CONCLUSION: EMA represents a promising methodology to capture real-time ENDS use behaviors, primarily through daily diary and random EMAs.

Building a health communication brand for University of Texas System tobacco control.

Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.

Adolescent Tobacco Uptake and Other Substance Use: A Latent Class Analysis.

Objective: The purpose of this study was to identify patterns of tobacco uptake and other substance use, from early to late adolescence. Methods: We used weighted latent class analysis, conducted separately for 7th, 9th, and 11th graders, to assess patterns of susceptibility, ever and current use of combustible tobacco and e-cigarettes, and other substance use (ie, current alcohol, binge drinking, and marijuana). Data were from Wave 3 of the Texas Adolescent Tobacco and Marketing Surveillance System (n = 2733; N = 461,069), collected in fall 2015. Multinomial regression was used to examine differences in class membership by demographic factors. Results: Two latent classes were identified in 7th grade, 3 classes in 9th grade, and 4 classes in 11th grade models. In each grade, classes included both a "no risk" and a "tobacco susceptible" class. For 9th grade, there was an additional "tobacco ever use" class, and 11th grade had the same additional class as well as an "all products use" class. Conclusion: Distinct patterns of polysubstance use emerged as grade level increased, supporting a stage-sequential model of onset and progression across developmental age groups. Future research can examine other factors affecting transitions across these stages.

Patterns of sustained e-cigarette use in a sample of young adults.

INTRODUCTION: E-cigarette use and devices are rapidly changing, yet there is not much scientific evidence examining these changes over time. The purpose of this study is to describe patterns of e-cigarette use in a sample of sustained (i.e., reporting past 30-day e-cigarette use at every wave) e-cigarette users over a two-year period. METHODS: Data are drawn from five waves of the Project M-PACT cohort. Analyses are limited to those reporting past 30-day e-cigarette use at each wave (n = 75). Mixed effects regressions were conducted for the following dependent variables: device type, number of days used, combustible tobacco product use, and symptoms of nicotine dependence. Each model used survey wave as the time variable, and controlled for sociodemographic variables. RESULTS: Among sustained users, the majority reported using a rechargeable device. The average number of days used was about 2 for disposable devices and 14 for rechargeable devices (p < .0001). The odds of combustible tobacco product use decreased over time (AOR = 0.71; 95% CI 0.57-0.89), while symptoms of e-cigarette nicotine dependence increased over time (ß = 0.07 SE = 0.03, p-value = .02). For both e-cigarette device types, there were no changes in device type or number of days used over time. CONCLUSION: This is one of the first studies to look at changes in e-cigarette use, including symptoms of dependence and number of days used over a two-year period. This brief report extends the current literature by examining more than the prevalence and frequency of e-cigarette use.