U.S. digital tobacco marketing and youth: A narrative review.

We describe findings from peer-reviewed articles on digital tobacco marketing (DTM) using U.S. data related to youth, including research that examines use of age restrictions, DTM exposure and engagement, and associated tobacco use. We searched PubMed, EMBASE, Web of Science, and EBSCOhost in May 2019 and May 2020 for published English language peer-reviewed articles examining DTM that were published from January 2016 to May 2020. Inclusion coding occurred in three stages. The first search identified 519 articles; 167 were coded for inclusion. The second search identified 189 articles; 67 were coded for inclusion. Two coders then assessed whether the included articles mentioned youth (age 18 and younger) or age restrictions in the method and results sections of the full text. Ultimately, 47 articles were included in this review. A codebook was developed and tested through training. Each article was coded for age restrictions, youth exposure to DTM, youth engagement with DTM, and youth tobacco use associated with DTM exposure or engagement. The studies reviewed indicate that DTM on social media was infrequently age-restricted and the stringency of age restriction varied by tobacco product, site owner, and channel. Youth reported being exposed to DTM frequently via the Internet. While youth reported less frequently engaging with DTM compared to being exposed, engagement increased over time. DTM exposure and engagement were associated with tobacco product use. The studies reviewed document an association between DTM exposure and engagement and future tobacco use; thus, DTM may be contributing to the youth tobacco epidemic.

School Use and Normative Perceptions of Electronic Nicotine Product Use Among Middle and High School Students-November 2018.

PURPOSE: This study examined U.S. middle and high school student observations of electronic nicotine product (ENP) use in and around the school building and students' normative perceptions of use among peers. METHODS: Adolescents and young adult participants enrolled in middle (n = 672) or high school (n = 962) were recruited from an online nationally representative panel and surveyed from November 2 to 15, 2018. They answered questions on observed ENP use in and around the school building as well as perceptions of use among peers. RESULTS: Nearly one in five U.S. middle and high school students believed that at least half of their peers used ENPs. Confirming anecdotal reports, nearly six in 10 reported ever seeing someone use ENPs in or around their school, most often outside the school building and in bathrooms or locker rooms. CONCLUSIONS: The findings of this study underscore the importance of targeted prevention strategies and education efforts to prevent and combat adolescent ENP use in and around schools.

Factors That Mattered in Helping Travelers From Countries With Ebola Outbreaks Participate in Post-Arrival Monitoring During the 2014-2016 Ebola Epidemic.

During the 2014-2016 Ebola epidemic in West Africa, the US Centers for Disease Control and Prevention (CDC) developed the CARE+ program to help travelers arriving to the United States from countries with Ebola outbreaks to meet US government requirements of post-arrival monitoring. We assessed 2 outcomes: (1) factors associated with travelers' intention to monitor themselves and report to local or state public health authority (PHA) and (2) factors associated with self-reported adherence to post-arrival monitoring and reporting requirements. We conducted 1195 intercept in-person interviews with travelers arriving from countries with Ebola outbreaks at 2 airports between April and June 2015. In addition, 654 (54.7%) of these travelers participated in a telephone interview 3 to 5 days after intercept, and 319 (26.7%) participated in a second telephone interview 2 days before the end of their post-arrival monitoring. We used regression modeling to examine variance in the 2 outcomes due to 4 types of factors: (1) programmatic, (2) perceptual, (3) demographic, and (4) travel-related factors. Factors associated with the intention to adhere to requirements included clarity of the purpose of screening (B = 0.051, 95% confidence interval [CI], 0.011-0.092), perceived approval of others (B = 0.103, 95% CI, 0.058-0.148), perceived seriousness of Ebola (B = 0.054, 95% CI, 0.031-0.077), confidence in one's ability to perform behaviors (B = 0.250, 95% CI, 0.193-0.306), ease of following instructions (B = 0.053, 95% CI, 0.010-0.097), and trust in CARE Ambassador (B = 0.056, 95% CI, 0.009-0.103). Respondents' perception of the seriousness of Ebola was the single factor associated with adherence to requirements (odds ratio [OR] = 0.81, 95% CI, 0.673-0.980, for non-adherent vs adherent participants and OR = 0.86, 95% CI, 0.745-0.997, for lost to follow-up vs adherent participants). Results from this assessment can guide public health officials in future outbreaks by identifying factors that may affect adherence to public health programs designed to prevent the spread of epidemics.

Youth who use e-cigarettes regularly: A qualitative study of behavior, attitudes, and familial norms.

Limited research exists describing youth who use e-cigarettes on a regular basis, including knowledge of nicotine levels, health effects, and plans for future use. This qualitative study explored the patterns of use, social and familial norms, and perceptions of health effects among this group. Youth (N = 43), 14-17 years old, who described themselves as regular e-cigarette users, participated in 4 focus group discussions in Miami, Florida, and Raleigh, North Carolina in February 2016. Youth often initiated or continued e-cigarette use with a device obtained from a friend or family member, and often do not own their own device. They cite the flavors and doing tricks as the two main reasons they initially used e-cigarettes. Many reported that their family members are aware they use e-cigarettes, and that they have received implicit and explicit messages from family members that are positive toward ecigarette use. They are aware of the negative effects of nicotine, including addiction, but not confident that they are using e-liquids without nicotine. Participants reported they will stop using e-cigarettes when they become aware of reported negative health effects. Parents and family members are an important target audience for prevention campaigns and health messaging, given that their own use and acceptance could be encouraging initiation and continuation. Youth are using products containing nicotine and may be becoming addicted, even if they would not choose to use nicotine-containing e-juice. Increased awareness of negative health effects may encourage prevention and cessation of e-cigarette use among youth.

Smoke and Vapor: Exploring the Terminology Landscape among Electronic Cigarette Users.

OBJECTIVE: We explored the terminology of adult e-cigarette users in describing e-cigarette products and their use. We report how users discuss and differentiate these products and the language and culture surrounding them. METHODS: Focus groups (N = 12) were held in 5 locations in the United States between March and May, 2014. Participants (N = 99) included young adults or adults who were either exclusive or nonexclusive e-cigarette users. We gathered data on how users identify various types of e-cigarettes and how users understand and describe specific terms. RESULTS: Participants were familiar with the attributes of e-cigarettes in general but confused by the variety of products and unable to describe differences between product types. They were familiar with the term "vaping" even when they used "smoking" more frequently, and were clear that e-cigarettes do not produce traditional cigarette smoke. They had varied opinions about what to call regular users of e-cigarettes. CONCLUSIONS: Findings highlight that conceptual clarity, including using specific and familiar terminology and product descriptions for users and nonusers alike, is challenging and crucial. It is important that surveillance efforts, policy development, messaging, and future research reflect the language understood and used by consumers to enable widespread comprehension.