Graham, Amanda L

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.

Abstract Background To nurture a new online community for health behavior change, a fruitful strategy is to recruit “seed users” to create content and encourage participation. Purpose This study evaluated the impact of support from seed users in an online community for smoking cessation among people living with HIV/AIDS and explored the linguistic characteristics of their interactions. Methods These secondary analyses examined data from a randomized trial of a smoking cessation intervention for HIV+ smokers delivered via an online health community (OHC). The analytic sample comprised n = 188 participants randomized to the intervention arm who participated in the community. Independent variables were OHC interactions categorized by participant interlocutor type (study participant, seed user) and interaction type (active, passive). The primary outcome was biochemically verified 7-day abstinence from cigarettes measured 3 months post-randomization; 30-day abstinence was examined for robustness. Results Logistic regression models showed that participants’ interactions with seed users were a positive predictor of abstinence but interactions with other study participants were not. Specifically, the odds of abstinence increased as the number of posts received from seed users increased. Exploratory linguistic analyses revealed that seed users wrote longer comments which included more frequent use of “we” and “you” pronouns and that study participants users used more first-person singular pronouns (“I”). Conclusions Seeding a community at its inception and nurturing its growth through seed users may be a scalable way to foster behavior change among OHC members. These findings have implications for the design and management of an OHC capable of promoting smoking cessation.

Abstract Introduction We determined whether a tobacco cessation intervention targeting brief perioperative abstinence (“quit for a bit”) increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence (“quit for good”). Aims and Methods Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a “quit for a bit” or a “quit for good” intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS. Results The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for “quit for a bit” group (n = 48) and 22.2% [4.8, 46.0] for “quit for good” group (n = 50), p = .74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes on the morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, ie, alignment of intent with intervention did not affect engagement. Conclusions Tobacco cessation treatment delivered via SMS was well accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Implications Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via SMS was feasible and well utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Clinical Trial Number NCT03839043. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03839043

AbstractAimsTo evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase.DesignA parallel, two‐group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow‐up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020.SettingUnited States: a digital study conducted among new registrants on a free tobacco cessation website.ParticipantsEligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white).InterventionsThe treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone.MeasurementsThe primary outcome was self‐reported 30‐day point prevalence abstinence (ppa) at 9 months post‐randomization analyzed under intent to treat (ITT), counting non‐responders as smoking. Secondary outcomes included 3‐month measures of 30‐day ppa, intervention engagement and intervention satisfaction.FindingsAbstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69–1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26–0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028).ConclusionsA randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9‐month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.

Abstract Over the past 20 years, tobacco prevention and cessation efforts have evolved to keep pace with the changing tobacco product landscape and the widespread adoption of digital technologies. In 2019, Truth Initiative was awarded the Society of Behavioral Medicine’s Jessie Gruman Award for Health Engagement in recognition of the major role it has played on both fronts since its inception in 1999. This manuscript reviews the challenges and opportunities that have emerged over the past two decades, the evolving tactics deployed by Truth Initiative to engage people in tobacco prevention and cessation efforts, the approaches used to evaluate those efforts, and key achievements. It concludes with a summary of lessons learned and considerations for tobacco control researchers and practitioners to accelerate their impact on public health.

Abstract Introduction The prevalence of smoking among Somali Muslim male immigrants residing in Minnesota is estimated at 44%, however smoking reduction is common during the month of Ramadan. This study evaluated the feasibility and impact of a religiously tailored text message intervention delivered during Ramadan to encourage smoking reduction among Somali Muslim men who smoke. Methods Fifty Somali men were recruited. Participants received two text messages per day starting 1 week prior to and throughout the month of Ramadan. Approximately half were religiously tailored and half were about the risks of smoking and benefits of quitting. Smoking behavior was assessed at baseline, and at weeks 4 (end of Ramadan), 8, and 16. Outcomes included feasibility, acceptability, and preliminary impact of the text message intervention on smoking reduction and bioverified abstinence. Results The average age was 41 years. Average time to first cigarette was 1.8 hours at baseline, and 46% of participants smoked menthol cigarettes. Eighteen of 50 participants selected English and 32 selected Somali text messages. Subjects significantly reduced self-reported cigarettes per day (CPD) from 12.4 CPD at baseline to 5.8 CPD at week 16 (p &lt; 0.001). Seven subjects reported quitting at week 16, five completed CO testing, confirming self-reported abstinence. The majority of participants found the cultural and religious references encouraging at the end of the week 16 survey. Conclusions Religiously tailored text messages to decrease smoking are feasible and acceptable to Somali Muslim men who smoke during Ramadan. This intervention for addressing smoking disparities is worthy of further study. Implications Recruitment of Somali Muslim men who smoke is feasible and supports the idea that further studies targeting smoking during Ramadan are practical. Ramadan presents a window of opportunity upon which to build smoking cessation interventions for smokers who identify as Muslim. These preliminary findings suggest that text messaging is a feasible and acceptable intervention strategy, and that religious tailoring was well received. Such an approach may offer potential for addressing smoking disparities among Somali Muslim male smokers. Trial Registration ClinicalTrial.gov: NCT03379142