Awareness of and receptivity to FDA's point-of-sale tobacco public education campaign.

The purpose of the study was to assess awareness of and receptivity to FDA's point-of-sale (POS) tobacco public education campaign for adult cigarette smokers called Every Try Counts; it was the first multi-county POS campaign in the U.S. The design was a county-level treatment-control three-wave longitudinal design. The setting was 15 treatment and 15 control counties. Subjects were smokers ages 25 to 54 (N = 3,628). 4,145 individuals screened in as eligible; 3,628 (87.5% response rate) completed the Wave 1 questionnaire (Wave 2: n = 2,812; Wave 3: n = 2,571; retention 70.9%). Measures were self-reported brand and ad awareness (saw any ad a few times or more) and receptivity (5-item perceived effectiveness scale). The analysis included descriptive analyses of receptivity; bivariate analyses of awareness by treatment group; and covariate- and time-adjusted logistic regression models to determine changes in awareness attributable to the campaign. Receptivity was moderate and differed significantly by race/ethnicity. As was the case for all waves, at wave 3, ad awareness was significantly higher in treatment (53.3%) than control counties (36.1%, p < .05). In regression models, brand (OR = 1.53, 95% CI: 1.26-1.86) and ad (OR = 1.74, 95% CI: 1.39-2.16) awareness were significantly higher in treatment than control counties. Every Try Counts generated a moderate level of receptivity and attention from cigarette smokers. Limitations include self-reports of campaign awareness and generalizability to a small number of U.S. counties.

Perceived Safety, Not Perceived Legality, Mediates the Relationship Between Cannabis Legalization and Drugged Driving.

Cannabis legalization has rapidly spread throughout the United States and is associated with multiple public health outcomes, including driving under the influence of cannabis (DUIC). To improve understanding of the relationship between legalization and DUIC, we tested two potential mediators of this relationship: perceived safety and perceived legality of driving high. We analyzed data from 1,236 current (past 30-day) cannabis users who were recruited from states with recreational, medical only, or no legal cannabis between 2016 and 2017 using address-based and social media samples. Using a generalized linear model and adjusting for cannabis legalization, demographics, living in a state with a cannabis-specific drugged driving law, frequency of cannabis use, and weights, we found that perceived safety (risk ratio [RR] = 2.60, 95% CI [1.88, 3.58]), but not perceived legality (RR = 0.96, 95% CI [0.67, 1.37]), was significantly associated with DUIC. Perceived safety mediated the relationship between legalization and DUIC (Coeff: -0.12, 95% CI [-0.23, -0.01]). Models stratified by frequency of cannabis use yielded results consistent with those of pooled models except that, for frequent users, cannabis-specific driving laws were associated with a significantly lower risk of DUIC (RR = 0.64, 95% CI [0.44, 0.92]). Agencies developing cannabis-focused drugged driving educational campaigns should consider the potential role of perceived safety of driving high in DUIC campaigns.

The Impact of the Tips from Former Smokers® Campaign on Reducing Cigarette Smoking Relapse.

Evidence-based mass-reach health communication campaigns can increase tobacco cessation, use of cessation resources such as quitlines, and change tobacco-related social norms. These interventions have been associated with a lower likelihood of cigarette smoking relapse in studies conducted internationally; however, no studies have assessed this outcome for a national campaign in the United States. This study examined the relationship between Tips from Former Smokers® (Tips®) campaign exposure and the odds of cigarette smoking relapse among adults who formerly smoked. Using data from the 2014 to 2019 Tips longitudinal campaign surveys, we estimated first episode of relapse (versus remaining a former smoker) as a function of Tips gross rating points (GRPs, a measure of media exposure). Higher levels of Tips GRPs were associated with lower odds of relapse (aOR = 0.63, 95% CI: 0.50-0.78). These results suggest that the Tips campaign may reduce smoking relapse, in addition to the established effect of increasing smoking cessation. Former smokers can be considered a secondary target audience for smoking cessation mass media campaigns, and mass media campaigns could be considered a component of smoking relapse prevention efforts.

Cannabis legalization and driving under the influence of cannabis in a national U.S. Sample.

The relationship between cannabis legalization and traffic safety remains unclear. Physiological measures of cannabis impairment remain imperfect. This analysis used self-report data to examine the relationship between cannabis legalization and driving under the influence of cannabis (DUIC). Using a cross-sectional national sample (2016-2017) of 1,249 past-30-day cannabis users, we regressed self-reported DUIC (driving within three hours of "getting high") on cannabis legalization (recreational and medical (recreational), medical only (medical), or no legal cannabis), adjusting for demographics, days of use (past 30 days), days of use*legal status, calibration weights, and geographic clustering. The risk of DUIC in recreational (risk ratio [RR] = 0.41, 95% confidence interval (CI):0.23-0.72) and medical (RR = 0.39, 95% CI:0.20-0.79) states was lower than in states without legal cannabis, with one exception. Among frequent cannabis users (≥20 days per month), there was a significantly lower risk of DUIC for those living in recreational states (RR = 0.70, 95% CI: 0.49-0.99), but not for those living in medical states (RR = 0.87, 95% CI: 0.60-1.24), compared to users living in states without legal cannabis. The risk of self-reported DUIC was lower in recreational and medical cannabis states compared to states without legal cannabis. The only exception was for frequent users in medical states, for whom there was no difference in risk compared to frequent users living in states without legal cannabis.

Associations between smoking trajectories, smoke-free laws and cigarette taxes in a longitudinal sample of youth and young adults.

Cigarette smoking patterns vary within the population, with some individuals remaining never smokers, some remaining occasional users, and others progressing to daily use or quitting. There is little research on how population-level tobacco control policy interventions affect individuals within different smoking trajectories. We identified associations between tobacco control policy interventions and changes across different smoking trajectories among adolescents and young adults. Using 15 annual waves of data drawn from the National Longitudinal Survey of Youth 1997 (NLSY97), we applied a group-based trajectory model to identify associations between days smoked per month, comprehensive smoke-free laws, cigarette tax rates, and known socio-demographic risk factors for membership in different smoking trajectories. Comprehensive smoke-free laws were associated with reduced risk of initiation and reductions in days smoked per month for all trajectories other than occasional users. Higher tax rates were associated with reduced risk of initiation and days smoked for all trajectories other than established users. Overall, population-based tobacco control policies, particularly comprehensive smoke-free laws, were associated with reduced smoking. Tobacco taxes primarily reduced risk of initiation and use among never smokers, experimenters, and quitters, consistent with previous research suggesting that tobacco manufacturers lower prices after tax increases to reduce the cost of continued smoking for established users. These results provide support for expanding smoke-free laws and establishing a minimum tobacco floor price, which could improve public health by reducing the risk of initiation as well as use among occasional and established smokers.

Effects of e-cigarette use on cigarette smoking among U.S. youth, 2004-2018.

OBJECTIVE: To determine if the declining trend in U.S. youth cigarette smoking changed after e-cigarettes were introduced, and if youth e-cigarette users would have been likely to smoke cigarettes based on psychosocial and demographic predictors of smoking. METHODS: An interrupted time series analysis was used for cross-sectional data from the 2004 to 2018 National Youth Tobacco Surveys (NYTS) to assess changes in cigarette and e-cigarette use over time. A multivariable logistic regression model used 2004-2009 NYTS data on psychosocial risk factors to predict individual-level cigarette smoking risk from 2011 to 2018. Model-predicted and actual cigarette smoking behavior were compared. RESULTS: The decline in current cigarette smoking slowed in 2014 (-0.75 [95% CI: -0.81, -0.68] to -0.26 [95% CI: -0.40, -0.12] percentage points per year). The decline in ever cigarette smoking accelerated after 2012 (-1.45 [95% CI: -1.59, -1.31] to -1.71 [95% CI: -1.75, -1.66]). Ever and current combined cigarette and/or e-cigarette use declined during 2011-2013 and increased during 2013-2014 with no significant change during 2014-2018 for either variable. The psychosocial model estimated that 69.0% of current cigarette smokers and 9.3% of current e-cigarette users (who did not smoke cigarettes) would smoke cigarettes in 2018. CONCLUSIONS: The introduction of e-cigarettes was followed by a slowing decline in current cigarette smoking, a stall in combined cigarette and e-cigarette use, and an accelerated decline in ever cigarette smoking. Traditional psychosocial risk factors for cigarette smoking suggest that e-cigarette users do not fit the traditional risk profile of cigarette smokers.

Association of tobacco control policies with cigarette smoking among school youth aged 13-15 years in the Philippines, 2000-2015.

INTRODUCTION: In 2003, the Philippines implemented legislation that prohibited the sale of tobacco products to youth, placed text warning labels on tobacco products, and prohibited tobacco smoking in public places. This study assessed if this legislation was associated with reduced cigarette smoking among youth. METHODS: Data came from the 2000-2015 Philippines Global Youth Tobacco Survey (GYTS), a nationally representative, cross-sectional survey of students aged 13-15 years. GYTS data were used to determine associations between tobacco control legislation and current, past 30-day, current cigarette smoking (CCS). Logistic regression models were adjusted for age, sex, current other tobacco product use (COTPU), and price per cigarette stick (PPCS). RESULTS: In the unadjusted model, the 2003 legislation was not associated with CCS (OR=0.77; 95% CI: 0.54-1.10). After adjusting for covariates, it was negatively associated (AOR=0.65; 95% CI: 0.53-0.80). Being 15 years old (OR=1.31; 95% CI: 1.08-1.58), male (OR=2.54; 95% CI: 2.17-2.98), and COTPU (OR=4.12; 95% CI: 3.47-4.91) were positively associated with CCS in unadjusted models. In adjusted models, being 14 years old (AOR=1.29; 95% CI: 1.08-1.53), 15 years old (AOR=1.55; 95% CI: 1.31-1.84), male (AOR=2.49; 95% CI: 2.13-2.91), and COTPU (AOR=3.96; 95% CI: 3.32-4.73), were associated with CCS. PPCS was not associated with CCS in either the unadjusted (OR=1.32; 95% CI: 0.82-2.11) or adjusted (AOR=1.32; 95% CI: 0.79-2.18) models. CONCLUSIONS: After adjusting for covariates, the 2003 tobacco control legislation was associated with lower current cigarette smoking, but price per cigarette stick was not.

Effect of menthol cigarette and other menthol tobacco product bans on tobacco purchases in the RTI iShoppe virtual convenience store.

OBJECTIVE: To test how a potential US ban of menthol products or replacement with 'green' products and ads could influence tobacco purchases. METHODS: US adult menthol smokers (N=1197) were recruited via an online panel and randomly assigned to complete a shopping task in one of four versions (experimental conditions) of the RTI iShoppe virtual store: (1) no ban, (2) replacement of menthol cigarettes and ads with green replacement versions, (3) menthol cigarette ban and (4) all menthol tobacco product ban. Logistic regressions assessed the effect of condition on tobacco purchases. RESULTS: Participants in the menthol cigarette ban (OR=0.67, 95% CI 0.48 to 0.92) and all menthol product ban conditions (OR=0.60, 95% CI 0.43 to 0.83) were less likely to purchase cigarettes of any type than participants in the no ban condition. Participants in the green replacement (OR=1.74, 95% CI 1.13 to 2.70), menthol cigarette ban (OR=3.40, 95% CI 2.14 to 5.41) and all menthol product ban conditions (OR=3.14, 95% CI 1.97 to 5.01) were more likely to purchase a cigarette brand different from their usual brand than participants in the no ban condition. CONCLUSIONS: Our findings suggest that menthol bans could have great public health impact by reducing cigarette purchases. However, tobacco marketing strategies, such as creating green (or other replacement) versions of menthol cigarettes, may undermine public health benefits of a menthol ban by prompting purchases of non-menthol cigarettes. Our findings highlight the importance of taking tobacco marketing tactics into consideration in tobacco product regulation.

Differential Relationship between Tobacco Control Policies and U.S. Adult Current Smoking by Poverty.

The study's purpose was to identify differences in the relationship between tobacco control policies and smoking by poverty. We matched state smoke-free air law coverage (SFALs), tobacco control funding (TCF), and cigarette taxes with individual current smoking and demographics from supplements to the Current Population Survey (1985-2015). We regressed (logistic) smoking on policy variables, poverty (<138% of poverty line versus ≥138% of poverty line), interactions of policy and poverty, and covariates, presenting beta coefficients instead of odds ratios because it is difficult to interpret interactions using odds ratios (they are ratios of odds ratios). We coded SFALs as (1) proportion of state covered by 100% workplace, restaurant and bar laws (SFAL-All) or (2) proportion of state covered by workplace laws (SFAL-WP) and proportion covered by restaurant or bar laws (SFAL-RB). In the SFAL-All model, SFAL-All (Beta coeff: -0.03, 95% CI: -0.06, -0.002), tax (Coeff: -0.06, 95% CI: -0.07, -0.05), and TCF (Coeff: -0.01, 95% CI: -0.01, -0.001) were associated with less smoking. In this model, the interaction of SFAL-All by poverty was significant (Coeff: 0.08, 95% CI: 0.02, 0.13). In the SFAL-WP/RB model, SFAL-RB (Coeff: -0.05, 95% CI: -0.08, -0.02), tax (Coeff: -0.05, 95% CI: -0.06, -0.04), and TCF (Coeff: -0.01, 95% CI: -0.01, -0.00) were significant. In the same model, SFAL-WP (Coeff: 0.09, 95% CI: 0.03, 0.15), SFAL-RB (Coeff: -0.14, 95% CI: -0.19, -0.09), and TCF (Coeff: 0.01, 95% CI: 0.00, 0.02) interacted with poverty. Tax by poverty was of borderline significance in this model (Coeff = 0.02, 95% CI: -0.00, 0.04, p = 0.050). Among adults, SFALs, TCF, and tax were associated with less current smoking, and SFALs and TCF had differential relationships with smoking by poverty.

Antismoking Advertisements and Price Promotions and Their Association With the Urge to Smoke and Purchases in a Virtual Convenience Store: Randomized Experiment.

BACKGROUND: Point of sale (POS) advertising is associated with smoking initiation, current smoking, and relapse among former smokers. Price promotion bans and antismoking advertisements (ads) are 2 possible interventions for combating POS advertising. OBJECTIVE: The purpose of this analysis was to determine the influence of antismoking ads and promotions on urges to smoke and tobacco purchases. METHODS: This analysis examined exposure to graphic (graphic images depicting physical consequences of tobacco use) and supportive (pictures of and supportive messages from former smokers) antismoking ads and promotions in a virtual convenience store as predictors of urge to smoke and buying tobacco products among 1200 current cigarette smokers and 800 recent quitters recruited via a Web-based panel (analytical n=1970). We constructed linear regression models for urge to smoke and logistic regression models for the odds of purchasing tobacco products, stratified by smoking status. RESULTS: The only significant finding was a significant negative relationship between exposure to supportive antismoking ads and urge to smoke among current smokers (beta coefficient=-5.04, 95% CI -9.85 to -0.22; P=.04). There was no significant relationship between graphic antismoking ads and urge to smoke among current smokers (coefficient=-3.77, 95% CI -8.56 to 1.02; P=.12). Neither relationship was significant for recent quitters (graphic: coefficient=-3.42, 95% CI -8.65 to 1.81; P=.15 or supportive: coefficient=-3.82, 95% CI -8.99 to 1.36; P=.20). There were no significant differences in urge to smoke by exposure to promotions for current smokers (coefficient=-1.06, 95% CI -4.53 to 2.41; P=.55) or recent quitters (coefficient=1.76, 95% CI -2.07 to 5.59; P=.37). There were also no differences in tobacco purchases by exposure to graphic (current smokers: coefficient=0.93, 95% CI 0.67 to 1.29; P=.66 and recent quitters: coefficient=0.73, 95% CI 0.44 to 1.19; P=.20) or supportive (current smokers: coefficient=1.05, 95% CI 0.75 to 1.46; P=.78 and recent quitters: coefficient=0.73, 95% CI 0.45 to 1.18; P=.20) antismoking ads or price promotions (current smokers: coefficient=1.09, 95% CI 0.86 to 1.38; P=.49 and recent quitters: coefficient=0.90, 95% CI 0.62 to 1.31; P=.60). CONCLUSIONS: The results of this analysis support future research on the ability of supportive antismoking ads to reduce urges to smoke among current cigarette smokers. Research on urges to smoke has important tobacco control implications, given the relationship between urge to smoke and smoking cigarettes, time to next smoke, and amount smoked.

Imitating waterpipe: Another tobacco industry attempt to create a cigarette that seems safer.

INTRODUCTION: The use of waterpipe (also known as hookah) increased between 2011 and 2016 in the US and globally, especially among youth and young adults. The aim of this study is to examine the tobacco industry's interest, involvement and role in proliferating waterpipe-like products and its technology. METHODS: We searched the University of California San Francisco Truth Tobacco Industry Documents beginning with the search terms "hookah', 'waterpipe', 'narghile', 'shisha', 'hooka', 'e-hookah', 'electronic hookah', 'water filtration', and 'hubble-bubble' and then expanded the search using snowball sampling. Over 1500 documents were reviewed, and 39 were included in this analysis. RESULTS: This review focuses on several companies' addition of water to the filter of one cigarette holder and to two cigarettes in an attempt to make these products seem safer. In 1954, the Aquafilter Corporation created and patented a filtered cigarette holder named Aquafilter, which the documents reveal was closely monitored by multiple tobacco companies. In 1965, the American Tobacco Company developed the Waterford cigarette. In 1987, Japan Tobacco patented the Rivage cigarette. Waterford and Rivage were very similar products that contained crushable water capsules designed to "wet" the cigarettes' filter. CONCLUSION: Companies have been attempting to incorporate the water filtrating aspect of waterpipe into cigarette products. Ultimately, several tobacco companies adapted the technology from these devices to create cigarettes with crushable flavor capsules. Given the tobacco industry's history of resurrecting products, the industry may attempt to incorporate water filtration and other aspects of waterpipe into future products to attempt to make them appear safer.

Revolution or redux? Assessing IQOS through a precursor product.

BACKGROUND: Philip Morris International (PMI) currently claims that its heated tobacco product, IQOS, reduces health risk by reducing users' exposure to harmful and potentially harmful constituents present in tobacco smoke. Given the tobacco industry's long history of misrepresenting and obfuscating research, independent assessment of PMI's claims is important. Analysis of Accord, a failed but strikingly similar precursor to IQOS, may help contextualise PMI's claims in its Modified Risk Tobacco Product (MRTP) application. METHODS: We analysed previously secret internal Philip Morris (PM) and PMI documents, public communications and MRTP application. RESULTS: PM marketed Accord as a 'cleaner' tobacco product in an attempt to address smokers' growing health concerns without making explicit health claims. While PM communications asserted that Accord reduced users' exposure to harmful constituents, company scientists and executives consistently stressed to both regulators and the public that such reductions did not render Accord safer. IQOS's design and marketing are similar to Accord's. On the basis of aerosol chemistry data, IQOS reduces user exposure to some compounds compared with Accord but raises them for others. DISCUSSION: IQOS appears to be a variant of Accord without consistent improvements in exposure to aerosol toxic compounds. In contrast to PM's past claims for Accord, PMI now claims in its MRTP application that IQOS reduces health risk. This shift in stance is likely not the result of any toxicological difference between Accord and IQOS, but rather a change in the social and regulatory landscape permitting these claims.

Deception and Shopping Behavior Among Current Cigarette Smokers: A Web-Based, Randomized Virtual Shopping Experiment.

BACKGROUND: Virtual stores can be used to identify influences on consumer shopping behavior. Deception is one technique that may be used to attempt to increase the realism of virtual stores. OBJECTIVE: The objective of the experiment was to test whether the purchasing behavior of participants in a virtual shopping task varied based on whether they were told that they would receive the products they selected in a virtual convenience store (a form of deception) or not. METHODS: We recruited a US national sample of 402 adult current smokers by email from an online panel of survey participants. They completed a fully automated randomized virtual shopping experiment with a US $15 or US $20 budget in a Web-based virtual convenience store. We told a random half of participants that they would receive the products they chose in the virtual store or the cash equivalent (intervention condition), and the other random half simply to conduct a shopping task (control condition). We tested for differences in demographics, tobacco use behaviors, and in-store purchases (outcome variable, assessed by questionnaire) by experimental condition. RESULTS: The characteristics of the participants (398/402, 99.0% with complete data) were comparable across conditions except that the intervention group contained slightly more female participants (103/197, 52.3%) than the control group (84/201, 41.8%; P=.04). We did not find any other significant differences in any other demographic variables or tobacco use, or in virtual store shopping behaviors, including purchasing any tobacco (P=.44); purchasing cigarettes (P=.16), e-cigarettes (P=.54), cigars (P=.98), or smokeless tobacco (P=.72); amount spent overall (P=.63) or on tobacco (P=.66); percentage of budget spent overall (P=.84) or on tobacco (P=.74); number of total items (P=.64) and tobacco items purchased (P=.54); or total time spent in the store (P=.07). CONCLUSIONS: We found that telling participants that they will receive the products they select in a virtual store did not influence their purchases. This finding suggests that deception may not affect consumer behavior and, as a result, may not be necessary in virtual shopping experiments.

Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008-2015.

Although research has established a link between cannabis legalization and use, and cannabis use and mental health, the relationship between medical cannabis legalization and mental health remains uncharacterized. This analysis investigated the relationship between state medical cannabis laws (restrictive, i.e. covering a narrow set of medical conditions; or liberal, i.e. covering a broad range of medical conditions), whether the law permits patients to petition their physician to approve medical cannabis use for specific medical conditions, and state prevalence of serious mental illness (SMI) in the National Survey of Drug Use and Health 2008-2015. In a covariate-adjusted meta-regression, liberal laws were significantly associated with higher prevalence of SMI (Coeff = 0.003, SE = 0.001, p < .001). Restrictive laws (Coeff = 0.001, SE = 0.001, p = .285) and the ability to petition physician approval (Coeff = -0.001, SE = 0.001, p = .140) were non-significant. When added to the model, state past-year cannabis use was significantly associated with higher prevalence of SMI (Coeff = 0.037, SE = 0.015, p = .018), liberal laws remained significant (Coeff = 0.002, SE = 0.001, p = .015), and restrictive laws (Coeff = -0.0001, SE = 0.001, p = .945) and the ability to petition a physician (Coeff = 0.001, SE = 0.001, p = .290) remained non-significant. Medical cannabis laws are likely related to state mental health, and a higher prevalence of cannabis use partially explains this relationship.

Impact of E-Cigarette Minimum Legal Sale Age Laws on Current Cigarette Smoking.

PURPOSE: The purpose of this study was to use individual-level data to examine the relationship between e-cigarette minimum legal sale age (MLSA) laws and cigarette smoking among U.S. adolescents, adjusting for e-cigarette use. METHODS: In 2016 and 2017, we regressed (logistic) current (past 30-day) cigarette smoking (from 2009-2014 National Youth Tobacco Surveys [NYTS]) on lagged (laws enacted each year counted for the following year) and unlagged (laws enacted January-June counted for that year) state e-cigarette MLSA laws prohibiting sales to youth aged <18 or <19 years (depending on the state). Models were adjusted for year and individual- (e-cigarette and other tobacco use, sex, race/ethnicity, and age) and state-level (smoke-free laws, cigarette taxes, medical marijuana legalization, income, and unemployment) covariates. RESULTS: Cigarette smoking was not significantly associated with lagged MLSA laws after adjusting for year (odds ratio [OR] = .87, 95% confidence interval [CI]: .73-1.03; p = .10) and covariates (OR = .85, .69-1.03; p = .10). Unlagged laws were significantly and negatively associated with cigarette smoking (OR = .84, .71-.98, p = .02), but not after adjusting for covariates (OR = .84, .70-1.01, p = .07). E-cigarette and other tobacco use, sex, race/ethnicity, age, and smoke-free laws were associated with cigarette smoking (p <.05). Results unadjusted for e-cigarette use and other tobacco use yielded a significant negative association between e-cigarette MLSA laws and cigarette smoking (lagged: OR = .78, .64-.93, p = .01; unlagged: OR = .80, .68-.95, p = .01). CONCLUSIONS: After adjusting for covariates, state e-cigarette MLSA laws did not affect youth cigarette smoking. Unadjusted for e-cigarette and other tobacco use, these laws were associated with lower cigarette smoking.

Perceptions of the relative harmfulness of marijuana and alcohol among adults in Oregon.

This study documents perceptions of the relative harmfulness of marijuana and alcohol to a person's health among adults in Oregon just before the first legal sales of marijuana for recreational use. We surveyed 1941 adults in Oregon in September 2015. Respondents were recruited using an address-based sampling (ABS) frame (n = 1314) and social media advertising (n = 627). Respondents completed paper surveys (ABS-mail, n = 388) or online surveys (ABS-online, n = 926; social media, n = 627). We used descriptive statistics and logistic regression models to examine perceptions of the relative harmfulness of marijuana and alcohol by sample characteristics, including substance use. About half of adults in Oregon (52.5%) considered alcohol to be more harmful to a person's health than marijuana. A substantial proportion considered the substances equally harmful (40.0%). Few considered marijuana to be more harmful than alcohol (7.5%). In general, respondents who were younger, male, and not Republican were more likely than others to consider alcohol more harmful than marijuana. Respondents who were older, female, and Republican were more likely to consider marijuana and alcohol equally harmful. Most individuals who reported using both marijuana and alcohol (67.7%) and approximately half of those who used neither substance (48.2%) considered alcohol to be more harmful than marijuana. Perceptions about the relative harmfulness of marijuana and alcohol may have implications for public health. As state lawmakers develop policies to regulate marijuana, it may be helpful to consider the ways in which those policies may also affect use of alcohol and co-use of alcohol and marijuana.

Thirty-day smoking in adolescence is a strong predictor of smoking in young adulthood.

Thirty-day smoking, although a widely used measure of adolescent smoking (age 12-16), has been questioned as an accurate measure of young adult (age 26-30) smoking behavior, particularly when critiquing studies linking use of e-cigarettes with subsequent cigarette smoking. We used logistic regression to test two measures of 30-day adolescent smoking as predictors of young adult smoking in the National Longitudinal Survey of Youth 1997. Adjusting for psychosocial covariates, compared to those who smoked zero days in the past 30 days in adolescence, odds of any past-30-day smoking in young adulthood ranged from 2.85 (95% CI: 1.85-4.37) for those who smoked 1 day to 4.81 (3.50-6.59) for those who smoked daily as adolescents, and adjusted odds of daily smoking in young adulthood ranged from 1.99 (1.24-3.18) to 4.69 (3.42-6.43). Compared with adolescent never smokers, adjusted odds of any past-30-day smoking in young adulthood among adolescent former smokers was 2.11 (1.77-2.53), and among adolescent current smokers, ranged from 3.03 (2.22-4.14) for those who smoked 1-5 cigarettes per month to 8.19 (5.80-11.55) for those who smoked daily. Adjusted odds of daily smoking in young adulthood were 2.49 (2.12-2.91) for adolescent former smokers and, among adolescent current smokers, ranged from 2.54 (1.92-3.37) for those who smoked 1-5 cigarettes per month to 8.65 (6.06-12.35) for those who smoked daily. There is a strong dose-response relationship between 30-day smoking in adolescence-even a single day in the month-and 30-day and daily smoking in young adulthood.

Smokers' Attention to Point-of-Sale Antismoking Ads: An Eye-tracking Study.

OBJECTIVES: We used eye-tracking to examine smokers' visual attention in one of 4 antismoking ad contexts (alone, next to cigarette ad, tobacco display, or cooler). Participants viewed 4 ad types (graphic, intended emotive, and benefits of quitting-graphic ads, and benefits of quitting-informational ads), each with 3 areas of interest (AOI) (anti-ad image, anti-ad text, and other text). METHODS: Current smokers (N = 153) viewed ads for 10 seconds each. Multivariable random effect linear regressions with post-test comparisons (with sidak-adjusted p-values) were used to test for differences in fixations and dwell time by ad context and type while adjusting for covariates. Visual attention was adjusted by percentage of anti-ad area taken up by each AOI. RESULTS: Adjusting for covariates, there were no differences by ad context (p > .05). Fixations and dwell time were greatest for the image of the benefits of quitting-graphic ad, the text of the graphic ad, and the other text of the intended emotive ad (all ps < .005). Conclusions: Visual attention to antismoking ads did not vary by ad context but varied significantly by ad type.

Differences in Adolescent E-cigarette and Cigarette Prevalence in Two Policy Environments: South Korea and the United States.

Introduction: In the context of different regulatory environments, different patterns of e-cigarette use have emerged among adolescents worldwide. The United States and South Korea are two examples, the latter of which has maintained much more extensive regulation of e-cigarettes. Methods: This analysis compares the prevalence of e-cigarette and conventional cigarette use between 2011 and 2015 from the Korean Youth Risk Behavior Web-based Survey and the U.S. National Youth Tobacco Survey, both nationally representative samples of middle and high school students that use similar questions. Results: E-cigarette prevalence (past 30 days) among South Korean adolescents decreased from 4.7% in 2011 (95% confidence interval [CI]: 4.4-5.0) to 4.0% (3.7-4.3) in 2015 but increased dramatically among US adolescents from 0.9% (0.7-1.2) to 11.2% (9.9-12.7). Cigarette prevalence (past 30 days) decreased in South Korea from 12.1% (11.6-12.7) to 7.8% (CI: 7.3-8.3) and in the United States from 11.1% (9.5-12.6) to 6.1% (5.1-7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in South Korea from 13.2% (12.7-13.8) to 8.5% (8.0-9.1) but increased in the United States from 11.3% (9.7-12.9) to 14.0% (12.4-15.7). Conclusions: In South Korea, where e-cigarettes are extensively regulated, adolescent e-cigarette use remained stable at a low level, whereas in the United States, where e-cigarette regulation has been limited, e-cigarette use increased. Combined e-cigarette plus cigarette use declined in South Korea whereas it increased in the United States. The restrictive policies in South Korea likely contributed to lower overall product use. Implications: This paper compared the strength of regulation of South Korea and the United States with the prevalence of adolescents' e-cigarette and cigarette use and suggests that more restrictive policies likely to contribute to lower e-cigarette use and overall use of e-cigarette and cigarette.