Not-so-disposable e-cigarettes: Methods young people use to discard single-use e-cigarettes.

BACKGROUND AND AIMS: To date, most tobacco product waste research focuses on cigarettes. Less is known about single-use 'disposable' e-cigarette waste, which contains several hazardous and toxic materials. This exploratory study examines self-reported methods for discarding disposables among a national sample of US adolescents and young adults. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Data were obtained from a weekly cross-sectional survey of US residents aged 15-24 years. The analytical sample consisted of data collected from November 2022 to August 2023 from respondents who reported past-30-day use of disposables (n = 1313). Weighted multinomial logistic regressions examined the association between tobacco use behaviors and respondents' primary self-reported method for discarding disposables (reference group: 'throw them in the regular trash'), controlling for socio-demographic variables. FINDINGS: Approximately half of respondents discarded their empty disposables in the regular trash (52.9%). On average, respondents reported throwing away 3.1 disposables monthly [95% confidence interval (CI) = 2.83, 3.29]. Second most commonly, respondents reported keeping or collecting empty disposables (21.4%). Respondents who reported 10-30 days (versus 1-9) of past-month vaping were more likely to primarily keep or collect disposable e-cigarettes (relative risk reduction = 1.64, 95% CI = 1.20, 2.24) compared to discarding in the trash. CONCLUSIONS: Young people in the United States who use disposable e-cigarettes report primarily discarding their disposable e-cigarettes in the regular trash or keeping them. All reported disposal methods raise safety and environmental concerns.

Past-Year Mental Illness Diagnosis and E-cigarette Use Status Among a College-Aged Sample: Findings From the National College Health Assessment (2017-2019).

PURPOSE: To examine associations between past-year mental illness (MI) diagnoses and e-cigarette use status. DESIGN: Data were obtained from the National College Health Assessment, a nationally recognized cross-sectional survey of university students. SETTING: Participants were recruited from 2-year and 4-year public and private universities across the United States from 2017-2019. SUBJECTS: The analytic sample included 277 291 university students. MEASURES: Self-reported past-year MI diagnosis, binarily coded, served as the primary predictor. The outcome was e-cigarette use status (never, noncurrent, and current user). ANALYSIS: Multinomial logistic regression models were used to estimate relative risk ratios (RRR) of e-cigarette use, as predicted by past-year MI diagnoses, age, race/ethnicity, sex and gender, sexual identity, geographic region, and other combustible tobacco, alcohol, and marijuana use. RESULTS: Compared to those who had never received any MI diagnosis in the past year, those who did had a 16% higher relative risk (RRR = 1.16, 95% CI: 1.11, 1.20) of being a noncurrent e-cigarette user and a 33% higher relative risk (RRR = 1.33, 95% CI: 1.28, 1.38) of being a current e-cigarette user. Schizophrenia, substance use or addiction, bipolar disorder, and attention deficit and hyperactivity disorder (ADHD) diagnoses demonstrated the strongest associations with noncurrent and current e-cigarette use. CONCLUSION: Results suggest the need to screen young adults for e-cigarette use and mental health indicators to facilitate early detection and timely intervention for at-risk university students.

Pathways to Quitting E-cigarettes Among Youth and Young Adults: Evidence From the truth® Campaign.

PURPOSE: This study examines the pathways through which e-cigarette users' awareness of the truth® campaign influences e-cigarette use frequency over time. DESIGN AND SETTING: Data included four waves (2020-2023) of the Truth Longitudinal Cohort, a probability-based, nationally representative survey. PARTICIPANTS: The analytic sample was 15-24-year-olds who reported current e-cigarette use at baseline (N = 718). Wave-by-wave retention rates were 64% to 69%. MEASURES: Respondents' cumulative awareness of truth® ads was calculated (Waves 1-2). Strength of agreement with campaign-targeted attitudes was measured on five-point scales (Wave 2). The outcome was change in the 4-level frequency of e-cigarette use (Waves 2-4). ANALYSIS: Latent growth structural equation modeling examined the pathway from cumulative ad awareness to the frequency of e-cigarette use via campaign-targeted attitudes. RESULTS: Model fit estimates identified a three-step pathway by which awareness of the campaign reduced e-cigarette use. Ad awareness was significantly associated with stronger campaign-targeted attitudes: perceived risk (ß = .20, P < .0001); anti-vape industry (ß = .13, P = .003); independence from addiction (ß = .13, P = .004); and affinity with groups that reject vaping (ß = .18, P < .0001). Each attitude was significantly associated with stronger perceived norms against e-cigarette use (respectively: ß = .25, P < .0001; ß = .15, P < .0001; ß = .12, P = .018; ß = .27, P < .0001). Perceived norms against e-cigarette use had a significant negative relationship with growth in e-cigarette use frequency over time (ß = -.23, P < .0001). CONCLUSION: Greater truth® anti-vaping ad awareness strengthens campaign-targeted attitudes among current users, increasing perceived norms against e-cigarette use and reducing use over time.

E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018-2019).

This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.

Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study.

BACKGROUND: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. OBJECTIVE: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. METHODS: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google's Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. RESULTS: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=0.90, P<.001) and March 2020 to May 2022 (ρ=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ρ=0.90; P<.001; 18-20 years: ρ=0.87; P<.001; 21-24 years: ρ=0.88; P<.001), racial or ethnic minorities (ρ=0.86, P<.001), and respondents with lower socioeconomic status (ρ=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ=0.92, P<.001) and retail and recreation (ρ=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (ρ=0.68, P<.001) and parks (ρ=0.62, P<.001). A strong negative correlation was observed for places of residence (ρ=-0.78, P<.001), and a weak but significant positive correlation was found for workplaces (ρ=0.24, P<.001). CONCLUSIONS: The Transportation Security Administration's travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States.

Attitudes towards COVID-19 vaccination among incarcerated persons in the Federal Bureau of Prisons, June-July 2021.

OBJECTIVE: To understand the attitudes towards COVID-19 vaccination and trusted sources of vaccination-related information among persons incarcerated in the Federal Bureau of Prisons. METHODS: From June-July 2021, persons incarcerated across 122 facilities operated by the Federal Bureau of Prisons were invited to participate in a survey asking their reasons for receiving or declining COVID-19 vaccination and the information sources they relied upon to make these decisions. Descriptive analyses were conducted. RESULTS: A total of 130,789 incarcerated persons with known vaccination status were invited to participate in the survey. At the time of survey, 78,496 (62%) were fully vaccinated; 3,128 (3%) were partially vaccinated and scheduled to complete their second dose, and 44,394 (35%) had declined either a first or second dose. 7,474 (9.5%) of the fully vaccinated group and 2,302 (4.4%) of the group declining either a first or second dose chose to participate in the survey; an overall survey return rate of 7.6% (n = 9,905). Among vaccinated respondents, the most common reason given for accepting vaccination was to protect their health (n = 5,689; 76.1%). Individuals who declined vaccination cited concerns about vaccine side effects (n = 1,304; 56.6%), mistrust of the vaccine (n = 1,256; 54.6%), and vaccine safety concerns (n = 1,252; 54.4%). Among those who declined, 21.2% (n = 489) reported that they would choose to be vaccinated if the vaccine was offered again. Those who declined also reported that additional information from outside organizations (n = 1128; 49.0%), receiving information regarding vaccine safety (n = 841; 36.5%), and/or speaking with a trusted medical advisor (n = 565; 24.5%) may influence their decision to be vaccinated in the future. CONCLUSION: As the COVID-19 pandemic continues, it is important to increase vaccine confidence in prisons, jails, and detention facilities to reduce transmission and severe health outcomes. These survey findings can inform the design of potential interventions to increase COVID-19 vaccine uptake in these settings.

E-cigarette Device Type, Source, and Use Behaviors of Youth and Young Adults: Findings from the Truth Longitudinal Cohort (2020-2021).

Background: E-cigarette device types vary in the amount of nicotine delivered to users. Given that youth and young adults are using pod-based and disposable e-cigarettes with high nicotine concentrations, it is important to determine how e-cigarette use behaviors associated with nicotine dependence may differ across e-cigarette device type. Methods: Baseline information was collected from September 2020 to March 2021 and follow-up information was collected from July to October 2021 from the Truth Longitudinal Cohort. The final analytic sample included respondents (aged 15-24) who reported current use of e-cigarettes at either baseline or follow-up and provided information on the 4-item E-cigarette Dependence Scale (EDS). Differences in endorsement of items from the EDS by e-cigarette device type (pod-based, disposable, or tank) were assessed using chi-square tests. Results: Participants (N = 308) were evenly split on age (15-20, 21+) and gender. Most 15-20-year-olds used disposable e-cigarettes, while those 21+ years primarily used tank devices. Although EDS score did not differ by e-cigarette device type, positive endorsement of two items from the EDS significantly differed by e-cigarette device type. More tank users endorsed reaching for a device without thinking about it (tank: 92.6%; pod-based: 79.0%; disposables: 79.9%, p = 0.04) and vaping more before going into a situation where vaping is not allowed (tank: 92.9%; pod-based: 71.0%; disposables: 73.0%, p < 0.01). Conclusions: Findings have the potential to inform policy implementation by providing evidence for specific targets for regulatory action that can help to reduce the burdens of e-cigarette use among youth and young adults, as results suggest that tank device users are more likely to endorse use behaviors associated with nicotine dependence.

Underage Youth Continue to Obtain E-Cigarettes from Retail Sources in 2022: Evidence from the Truth Continuous Tracking Survey.

(1) Background: This study aims to describe the primary sources of e-cigarettes among young people and to explore how these sources may differ by individual-level characteristics. (2) Methods: Data were obtained from a cross-sectional, continuous tracking survey of participants. The analytic sample includes current e-cigarette users (aged 15-20 years) surveyed from January to August 2022 (N = 1296). Respondents provided information on e-cigarette source of acquisition, device type, and flavors used, as well as sociodemographic and residential characteristics. Chi-square tests were used to determine differences in source of acquisition by age, gender, race/ethnicity, United States (US) census region, urban-rural classification, flavors used, and device type. (3) Results: Although most current e-cigarette users obtained their devices through a social source (56.9%), a considerable proportion obtained e-cigarettes from a retail source (43.1%). The primary retail sources of e-cigarette acquisition were vape shops (22.0%) and gas station/convenience stores (15.9%). Source of e-cigarette acquisition differed by age, gender, US census region, flavors used, and device type, such that a lower proportion of those who were younger, female, residing in the West, and used vape pens had reported obtaining e-cigarettes via retail sources. (4) Conclusions: Results indicate that a significant proportion of youth report obtaining e-cigarettes from retail sources, despite the federal, state, and local policies that prohibit the sale of any tobacco products to those under the age of 21. Comprehensive retail regulations to help restrict tobacco product access are needed to reduce e-cigarette use among young people.

COVID-19 Vaccine Acceptability Among People Experiencing Homelessness in Central Florida and Southern Nevada, March-June 2021.

CONTEXT: Understanding COVID-19 vaccine acceptability among people experiencing homelessness is critical to improve vaccine coverage during the COVID-19 pandemic. Little is known about COVID-19 vaccine acceptability people experiencing unsheltered homelessness (PEUH). OBJECTIVE: To identify and describe motivators for receiving a COVID-19 vaccine and reasons for hesitancy, information sources utilized and trusted for vaccine decision making, logistical barriers to receiving vaccination, and what might increase comfortability to receive a COVID-19 vaccination among PEUH. DESIGN: Cross-sectional survey design, implemented from March to June 2021. SETTING: Two US cities: Las Vegas and Nevada (urban), and Orlando, Florida (suburban). PARTICIPANTS: People experiencing predominantly unsheltered homelessness accessing handwashing stations and other wrap-around social services at program sites managed by Clean the World Foundation. MAIN OUTCOME MEASURES: The main outcome measures assessed included survey responses about current vaccine receipt (if participants have already received one or more doses of a COVID-19 vaccine), intention to receive a COVID-19 vaccine if not already received, motivators for receiving or wanting to receive a vaccine, reasons for hesitancy or uncertainty about receiving a vaccine, sources of information regarding COVID-19 vaccines, and actual or anticipated logistical barriers or challenges to receiving COVID-19 vaccines. RESULTS: Among 864 participants, 465 (53.8%) were classified as "vaccine accepting," and 399 were classified "vaccine hesitant or undecided." The primary motivator to be vaccinated was to protect their health (212, 45.6%). Hesitant or undecided participants reported that vaccines were too new (269, 67.4%) or they needed more information (223, 55.9%) and were more likely to receive information from social media than accepting participants (80.0% vs 58.3%, P < .001). Logistical barriers to vaccination included distance to vaccination locations (85, 21.3%), lack of transportation (79, 19.8%), and limited time (64, 16%). CONCLUSIONS: Vaccination efforts to reach PEUH should consider how information and logistical needs may be addressed.

Vulnerable Populations Exposed to Lead-Contaminated Drinking Water within Houston Ship Channel Communities.

Recent events have drawn increased attention to potential lead exposures from contaminated drinking water. Further, homes with older infrastructure are at greatest risk due to the presence of the disinfectant chemical chloramine, which can leach lead from older pipes. There is a growing need to determine the extent of lead leaching especially within vulnerable communities and homes with children. This pilot study collected survey data and performed lead analysis on drinking water in the small community of Manchester in Houston, TX. Manchester is characterized by industrial sites, flooding, and a low socioeconomic population. Surveys and water analyses were completed on randomly selected homes (N = 13) and documented perceptions of participants on their drinking water regarding presence and concentration of lead. Lead was discovered in 30.8% of homes ranging from 0.6 to 2.4 (µg/L), all below the US Environmental Protection Agency action level of 15 ppb, but above the water standard goals. These findings further suggest that contaminated water is a broad issue requiring concerted efforts to ensure the health of US residents.