Factors Associated With Abstinence Among Young Adult Smokers Enrolled in a Real-world Social Media Smoking Cessation Program.

OBJECTIVE: Social media platforms are promising to provide smoking cessation support. This study aimed to identify baseline factors associated with cigarette smoking abstinence among young adult smokers enrolled in a real-world social media-based smoking cessation program. AIMS AND METHODS: We analyzed data from young adult smokers (aged 18-30 years) participating in a publicly available Facebook-based smoking cessation program serving the San Francisco Bay Area. The analytic sample consisted of 248 participants who completed both the baseline and follow-up surveys at 3 months. Multivariable logistic regression analysis determined baseline factors significantly associated with self-reported 7-day cigarette smoking abstinence at 3 months. RESULTS: Participants were race/ethnically diverse, well-educated, and 47.6% reported LGB + sexual identity. Those who reported dual use of cigarettes and e-cigarettes in the past 30 days (vs. cigarette use only), current alcohol users (vs. non-users), and those aged 25-30 years (vs. 18-24 years) were significantly less likely to report 7-day abstinence at 3 months. Non-daily smokers (vs. daily smokers) and those with high desire to quit smoking (vs. low to moderate desire) were more likely to report abstinence. Results also showed reduction in the percentage of e-cigarette and other tobacco product use among participants. CONCLUSIONS: Social media interventions may be more effective for young adult non-daily smokers and those with high desire to quit smoking. Smoking cessation programs may help reduce use of other tobacco products among treatment-seeking smokers. Smoking cessation interventions for young adults need to explicitly address dual use of cigarettes and e-cigarettes and use of alcohol. IMPLICATIONS: Findings of this study highlight the need for future interventions to address dual use of cigarettes and e-cigarettes and use of alcohol to improve cigarette smoking abstinence outcomes. The reduction in the use of other tobacco products among program participants indicates that social media smoking cessation programs may exert a broader positive influence on overall tobacco consumption. The large number of LGB+ smokers participating in the program suggests social media is a promising cessation channel for this hard-to-reach group, warranting further study.

Cigarette Gifting Among Nonsmokers in China: Findings From the International Tobacco Control China Survey.

INTRODUCTION: Cigarette gifting is commonly practiced in China and has contributed to the social acceptability and high prevalence of cigarette smoking in the country. As a result, nonsmokers in China are particularly susceptible to smoking. While previous studies have examined cigarette gifting behaviors among smokers, little is known about cigarette gifting among nonsmokers. AIMS AND METHODS: This study aimed to examine the percentage and correlates of giving and receiving cigarettes as gifts among adult nonsmokers in China. We analyzed nonsmokers (N = 1813) aged ≥18 years using data from the International Tobacco Control China Wave 5 Survey. Descriptive statistics summarized the characteristics of those who gave and received cigarettes as gifts. Multivariable logistic regression models were used to identify factors associated with the two behaviors. RESULTS: Among nonsmokers, 9.9% reported giving cigarettes as gifts to family or friends in the last 6 months. A higher level of knowledge about smoking harms was associated with lower adjusted odds of gifting cigarettes. Nonsmokers aged 25-39 years, with middle income, positive attitude toward cigarette gifts, exposure to anti-smoking information, and exposure to smoking promotion, and those who reported receiving cigarettes as gifts from family or friends were more likely to give cigarettes as gifts. A total of 6.6% of nonsmokers reported receiving cigarettes as gifts in the last 6 months. High education, neutral or positive attitude toward cigarette gifts, exposure to anti-smoking information, exposure to smoking promotion, and having smoking friends were associated with receiving cigarettes as gifts. CONCLUSIONS: It is concerning that Chinese cultural norms that support cigarette gifting have extended to giving nonsmokers cigarettes as gifts. Effective anti-smoking messages are needed. Changing the norms around cigarette gifting and increasing knowledge about smoking harms should help reduce cigarette gifting among nonsmokers. IMPLICATIONS: Easy access to cigarettes received as gifts, along with the wide acceptance of smoking in China, places Chinese nonsmokers in a risky position. More educational campaigns targeting nonsmokers to proactively prevent them from smoking are called for. The ineffectiveness of existing anti-smoking information highlights the need for more effective anti-smoking messages. That attitude toward cigarette gifts is the strongest predictor of giving cigarettes as gifts suggests the need for interventions to reverse the positive attitude about cigarette gifting to decrease the popularity of this activity.

Perceptions and Aspirations Toward Peer Mentoring in Social Media-Based Electronic Cigarette Cessation Interventions for Adolescents and Young Adults: Focus Group Study.

BACKGROUND: Social media offer a promising channel to deliver e-cigarette cessation interventions to adolescents and young adults (AYAs); however, interventions delivered on social media face challenges of low participant retention and decreased engagement over time. Peer mentoring has the potential to ameliorate these challenges. OBJECTIVE: The aim of this study was to understand, from both the mentee and potential mentor perspective, the needs, expectations, and concerns of AYAs regarding peer mentoring to inform the development of social media-based peer mentoring interventions for e-cigarette cessation among AYAs. METHODS: Seven focus groups, including four mentee groups and three potential mentor groups, were conducted with 26 AYAs who had prior experience with e-cigarette use and attempts to quit in the context of a social media-based e-cigarette cessation intervention. Discussion focused on preferred characteristics of peer mentors, expectations about peer mentoring, mentoring mode, mentor training, incentives for peer mentors, preferred social media platforms for intervention delivery, supervision, and concerns. Focus group transcripts were coded and analyzed using a thematic analysis approach. RESULTS: Overall, participants were receptive to peer mentoring in social media-based cessation interventions and believed they could be helpful in assisting e-cigarette cessation. Participants identified the most important characteristics of peer mentors to be of similar age and to be abstinent from e-cigarette use. Participants expected peer mentors would share personal experiences, provide emotional support, and send check-ins and reminders. Peer mentors supporting a group of mentees in combination with one-on-one mentoring as needed was the preferred mentoring mode. A group of 10 mentees with a mentor:mentee ratio of 1:3-5 was deemed acceptable for most participants. Participants expressed that mentor training should include emotional intelligence, communication skills, and the scientific evidence about e-cigarettes. Although monetary incentives were not the main motivating factor for being a peer mentor, they were viewed as a good way to compensate mentors' time. Instagram was considered an appropriate social media platform to deliver a peer-mentored intervention due to its functionality. Participants did not express many privacy concerns about social media-based peer mentoring, but mentioned that boundaries and community agreements should be set to keep relationships professional. CONCLUSIONS: This study reflects the needs and preferences of young people for a peer mentoring intervention to complement a social media program to support e-cigarette cessation. The next step will be to establish the feasibility, acceptability, and preliminary efficacy of such a peer mentoring program.

Delivering vaping cessation interventions to adolescents and young adults on Instagram: protocol for a randomized controlled trial.

BACKGROUND: Adolescent and young adult use of electronic nicotine delivery systems ("vaping") has increased rapidly since 2018. There is a dearth of evidence-based vaping cessation interventions for this vulnerable population. Social media use is common among young people, and smoking cessation groups on social media have shown efficacy in the past. The objective of this study is to describe the protocol for a randomized controlled trial (RCT) testing the efficacy of an Instagram-based vaping cessation intervention for adolescents and young adults. METHODS: Adolescents and young adults aged 13-21 residing in California who have vaped at least once per week in the past 30 days will be recruited through social media ads, community partners, and youth serving organizations. Participants will be randomly assigned to intervention or control conditions: the intervention group takes place on Instagram, where participants receive up to 3 posts per weekday for 25 days over 5 weeks; the control group will be directed to kickitca.org, a website offering links to chatline and texting cessation services operated by the California Smokers' Helpline. The primary outcome is biochemically verified 7-day point prevalence abstinence for nicotine vaping; secondary outcomes are vaping reduction by 50% or more, vaping quit attempts, readiness to quit vaping, confidence in ability to quit, desire to quit, commitment to abstinence, and use of evidence-based cessation strategies. Both the primary outcome and secondary outcomes will be assessed immediately, 3 months, and 6 months after the treatment. DISCUSSION: This is the first RCT to test a vaping cessation intervention delivered through Instagram. If effective, it will be one of the first evidence-based interventions to address vaping among adolescents and young adults and add to the evidence base for social media interventions for this population. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04707911, registered on January 13, 2021.

A Systematic Review of E-Cigarette Marketing Communication: Messages, Communication Channels, and Strategies.

Marketing plays a key role in increasing the popularity of e-cigarettes. We conducted a systematic review of the existing literature published between 2003 and 2019 in eight databases to describe e-cigarette marketing communication messages by communication channels and marketing communication strategies. Forty-one articles were included in the analysis after screening. Ten key messages were identified. Cessation and health-related benefits (each n = 31, 75.6%) were the most reported marketing communication messages, followed by sociability/lifestyle and use experience. The Internet (n = 32, 78.0%) was the most studied communication channel compared to print, TV/movie/radio, and point-of-sales (POS)/retail stores. The most studied marketing communication strategies were advertising (n = 28, 68.3%), followed by public relations and sales promotion. Published research studies reported consistent messages about e-cigarettes across communication channels and marketing communication strategies. Claims of smoking cessation and health-related benefits were widely identified in the existing literature. While therapeutic claims are prohibited, soft sell messages, such as social appeals, for which regulatory reach may be limited, may require educational campaigns. Internet marketing has attracted much attention, with limited studies on messages in print, TV/movie/radio, and POS/retail stores. The lack of studies of direct marketing messaging indicates a big gap between industry spending and academic research; more studies of messaging utilizing this strategy are needed.

Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study.

BACKGROUND: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers' access to smoking cessation treatment. OBJECTIVE: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. METHODS: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers' barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants' smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. RESULTS: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. CONCLUSIONS: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers.

Characterizing Participant Perceptions about Smoking-Cessation Pharmacotherapy and E-Cigarettes from Facebook Smoking-Cessation Support Groups.

The prevalence of smoking among young adults aged 19-28 years old in the United States persists at rates of 14.3%. Young adults underutilize pharmacotherapy for smoking cessation, and the use of e-cigarettes has increased. We analyzed comments from online smoking-cessation support groups to understand young-adult smokers' views of pharmacotherapy and e-cigarettes, to provide a more in-depth insight into the underutilization of pharmacotherapy. A qualitative analysis was performed on comments about pharmacotherapy and e-cigarettes from participants enrolled in online smoking-cessation support groups in 2016-2020. A codebook was developed with a deductive approach to code the comments, followed by thematic analysis. Eighteen themes were identified, with four dominant themes: interest, benefit, knowledge, and flavor. Participants expressed less interest in both nicotine-replacement therapy and e-cigarettes; moreover, they expressed unfamiliarity with and misconceptions about pharmacotherapy, and recognized the enticing flavors of e-cigarettes. Participants often felt e-cigarettes were not useful for smoking cessation, but the flavors of e-cigarettes were appealing for use. Participants had mixed opinions about the use of e-cigarettes for smoking cessation, but predominantly felt e-cigarettes were not useful for smoking cessation. The use of social media may be an effective way to address misconceptions about pharmacotherapy for smoking cessation and increase willingness to accept assistance.

Receiving and giving electronic cigarettes as gifts in China: Findings from International Tobacco Control China Survey.

Cigarette gifting is pervasive in China. As the Chinese are increasingly aware of harm from smoking cigarettes, e-cigarettes, often promoted as less harmful alternatives to cigarettes, may be viewed as appropriate gifts. This study is the first using population-based survey data to examine receiving and giving e-cigarettes as gifts in China. We analyzed 9,274 adults from Wave 5 of the International Tobacco Control China Survey, which was completed in July 2015. We found that the prevalence of receiving e-cigarettes as gifts was 1.3% among all respondents and 5.3% among urban smokers; the prevalence of giving e-cigarettes as gifts was 0.5% among all respondents and 1.2% among urban smokers. These prevalence estimates were very low among nonsmokers and rural respondents. Further analysis on urban smokers (N = 3,312) found that those aged 40-54 and 55+, those with high education levels, heavy smokers, and those who perceived e-cigarettes as equally/more harmful than cigarettes were more likely to receive e-cigarette gifts; and those who ever used e-cigarettes were significantly more likely to both receive and give e-cigarette gifts. Urban smokers with positive attitude about cigarette gifting were also more likely to give e-cigarette gifts to others, but those aged 55+ were less likely to gift e-cigarettes. Findings of this study indicate that the Chinese may perceive e-cigarettes as appropriate gifts for smokers, especially heavy smokers. Precautions should be taken to prevent e-cigarettes from becoming a gift choice for nonsmokers. Health campaigns designed to combat the social acceptance of cigarette gifting may also help reduce e-cigarette gifting.

Electronic cigarette related topics with conflicting arguments in Chinese newspapers.

INTRODUCTION: While debates on e-cigarettes are mainly conducted in scientific fora, media are the most accessible information source for the public, shaping their perceptions of health issues. This study is the first to examine e-cigarette related topics with conflicting arguments presented in Chinese newspapers. METHODS: The Chinese terms for 'e-cigarettes' were searched in a widely used Chinese news database Wisenews. Content analysis of the full text of 639 news articles was conducted to identify topics with conflicting arguments and examine whether the dominant argument in each topic changed across four time periods from 2004 to 2019. RESULTS: Twelve e-cigarette related topics with conflicting arguments were identified. The most frequently reported topic was health impact of e-cigarettes, followed by impact of secondhand aerosol exposure, smoking cessation, relative health impact of e-cigarettes compared to cigarettes, and e-cigarette policies outside China. At the same time, the price was the least frequently reported topic. Overall, negative arguments outnumbered positive arguments in the study period. The dominant arguments within many topics changed across time periods; however, within the topics of relative health impact of e-cigarettes compared to cigarettes, taste/flavor, and economic prospects of the industry, positive arguments were more frequently reported in almost all periods. Within the topics of addiction, policies in China, and policies outside China, negative arguments were more frequently reported in virtually all periods. CONCLUSIONS: Though overall the dominant argument about e-cigarettes and health was 'e-cigarettes are harmful', in the early time periods, e-cigarettes were reported as 'harmless' or even 'healthy'. As China began to regulate e-cigarettes, the reporting on e-cigarettes more frequently included the 'e-cigarettes are harmful' argument. The consistent, more frequent reporting of 'good e-cigarette taste/flavor' has the potential to attract young people to e-cigarette products. The increased reporting on policies unfavorable to e-cigarettes aligned with the growing number of regulations restricting e-cigarettes.

Longitudinal Associations Between Use of Tobacco and Cannabis Among People Who Smoke Cigarettes in Real-world Smoking Cessation Treatment.

OBJECTIVES: Cannabis use is common among people who use tobacco. However, little is known about the relationship between change in use of tobacco and cannabis over time. We examined the longitudinal associations between use of the two substances in a realworld smoking cessation context. METHODS: This study analyzed data from a 3-month smoking cessation program delivered via Facebook in the San Francisco Bay Area, USA during 2016-2020. The sample included 487 participants who smoked cigarettes ( Mage = 25.4 years old, 39.6% Male, 40.3% White). The regressors (ie, frequency or number of days during the past 30 days using cigarettes, e-cigarettes, and cigars) and the outcome (ie, frequency of cannabis use) were measured at both baseline and 3-month follow-up. Random-effects modeling examined the longitudinal associations between the regressors and the outcome controlling for alcohol use and baseline demographics. RESULTS: Participants who increased (or decreased) their frequency of use of cigarettes (ß = 0.17, 95% confidence interval [CI] = 0.10, 0.24), e-cigarettes (ß = 0.11, 95% CI = 0.05, 0.17), or cigars (ß = 0.19, 95% CI = 0.06, 0.32) also increased (or decreased) their frequency of cannabis use after 3 months. Sexual minority participants (vs heterosexuals) (ß = 2.12, 95% CI = 0.01, 4.24) and those whose education attainment being high school or less (vs higher education) (ß = 3.89, 95% CI = 1.25, 6.53) were more likely to increase their frequency of cannabis use over time. CONCLUSIONS: The findings indicated positive associations between change in use of tobacco and cannabis use. Promoting cessation among people who use tobacco may help to reduce their cannabis use.