Hair, Elizabeth C.

Background This study investigates factors associated with electronic cigarette (e-cigarette) use and secondhand exposure in vehicles among US youth and young adults. Methods Data were collected from an online panel survey of individuals (N=3482, aged 15–25 years) from July to December 2024. Analyses included those who reported using any tobacco product in the past 30 days and answered items measuring exposure to (N=2600) and/or use of e-cigarettes in vehicles (N=2366). Logistic regression models assessed predictors of e-cigarette use and exposure in vehicles, including demographic, psychosocial and tobacco use characteristics. Results Among all participants, 67.1% reported e-cigarette use in the past 30 days. Of those reporting current e-cigarette use (N=2336), 60.6% reported using their e-cigarette/vape while travelling by car in the past 30 days. Of those who answered the question measuring exposure to e-cigarette use in vehicles (N=2600), 69.3% reported being in a vehicle where someone was using e-cigarettes. Higher nicotine dependence and residence in small metro and non-metro areas were associated with greater odds of using e-cigarettes in vehicles. Just meeting basic expenses or meeting needs with a little left, household tobacco use and residence in small metro areas were associated with greater odds of secondhand e-cigarette exposure. Discussion Public health interventions should place a strong focus on education and increasing public awareness of the health consequences of e-cigarette use in vehicles to protect bystanders from secondhand e-cigarette exposure.

Background This study examines the geographic representativeness of people who smoke, among newly registered users of a free digital tobacco cessation program (‘EX’). Methods User-provided ZIP codes from EX® Program registrants were mapped to Rural Urban Continuum Codes (RUCC). Reach Ratios (ReRas) and 95% confidence intervals were used to determine the extent to which geographic representation in EX was proportionate to their representation in the national population of individuals who smoke, as obtained from the United States National Survey of Drug Use and Health (2018-2020). Under- and overrepresentation was demonstrated by ReRas <1 or >1, respectively. Joinpoint regression analyses were used to determine significant changes in trend for ReRas from 2013 to 2020. Results Individuals who reported smoking residing in nonmetro rural areas were significantly overrepresented in 2018 [ReRa = 1.18 (95% CI: 1.15, 1.23)], 2019 [ReRa = 1.10 (95% CI: 1.07, 1.13)], and 2020 [ReRa = 1.10 (95% CI: 1.06, 1.13)]. Individuals who reported smoking from small metro areas were also overrepresented from 2018 to 2020 [ReRas = 1.09 (95% CI: 1.06, 1.11); 1.06 (95% CI: 1.04, 1.08), and 1.05 (95% CI: 1.03, 1.08), respectively] and individuals who reported smoking from large metro areas were underrepresented during the same time frame [ReRas = 0.87 (95% CI: 0.85, 0.89); 0.92 (95% CI: 0.91, 0.94), and 0.93 (95% CI: 0.91, 0.94), respectively]. ReRas for large metro areas decreased from 2013 to 2018 (annual percentage change, APC = −3.26; 95% CI: −6.69, −1.91). ReRas for non-metro areas increased from 2013 to 2017 (APC = 7.35; 95% CI: 4.10, 17.63). Conclusions Results suggest that individuals that smoke residing in nonmetro rural areas and small metro areas are proportionally reached by a digital tobacco cessation program. However, there continues to be an underrepresentation of individuals who smoke from large metro areas, which warrants further study.

Background Increasing intentions to quit e-cigarettes among youth and young adults can reduce usage rates by making quit attempts more likely. This study assessed the potential impacts of a national media campaign, focused on building knowledge of e-cigarette use risks and cessation resources, on intentions to quit and campaign-targeted beliefs about mental health and quitting. Methods A national sample from a repeated cross-sectional online survey was collected from March 2022 to August 2023, among youth and young adults who reported e-cigarette use in the past 30 days (N=5169). Regression models were used to assess associations between weekly campaign awareness and frequency of exposure on intentions to quit e-cigarette use within the next 6 months and targeted beliefs related to mental health and quitting. Results Participants who were aware of both cessation and knowledge-building messaging were more likely to report intentions to quit e-cigarette use in the next 6 months (OR 1.43, (95% CI 1.21, 1.69)) and agree with quitting-related targeted beliefs (ORs 1.351.63) and a mental health targeted belief scale (b=1.14 (95% CI 0.69, 1.59)), relative those with no messaging awareness. The frequency of exposure to cessation messaging held a dose-response relationship with almost all outcomes. Conclusion Findings suggest that frequency and awareness of messaging that educates about e-cigarette harms to mental health and about cessation resources are associated with higher quitting intentions among young people who use e-cigarettes.