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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 48516

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Special Issue Editors

Dr. Michael Stephen Dunbar

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Guest Editor

RAND Corporation, Pittsburgh, PA 15213, USA
Interests: tobacco use prevention, vaping product use, poly-tobacco use, nicotine and cannabis co-use

Dr. Joan S. Tucker

E-Mail Website
Guest Editor

RAND Corporation, Santa Monica, CA 90407, USA
Interests: tobacco use; alternative tobacco products; cigarette smoking cessation; mHealth; vulnerable populations

Special Issue Information

Dear Colleagues,

Tobacco use is a leading cause of preventable death and disease worldwide, and combustible cigarette smoking accounts for the bulk of tobacco-related harms. The introduction of e-cigarettes and other non-combustible nicotine/tobacco products (e.g., heat-not-burn or heated tobacco products [HTPs]) has led to an increasingly diverse nicotine/tobacco landscape, such that individuals now have access to a wide array of products with varying health risk profiles. Such factors, in conjunction with evolving tobacco control efforts, have driven significant changes in prevalence and patterns of nicotine/tobacco product use across the globe in recent years. For example, in the United States, rates of combustible cigarette use have reached historic lows in many segments of the population, but there has been an alarming rise in rates of vaping product use among youths and young adults. In other countries, new-generation HTPs appear to be making inroads with both established adult cigarette smokers and adolescents. Concurrent use of multiple different types of nicotine/tobacco products has also become increasingly prevalent in many parts of the world. Examining emerging trends in use of combustible (e.g., cigarettes) and non-combustible products (e.g., e-cigarettes, HTPs) is critical for understanding the potential impact of different products on global public health and for informing ongoing efforts to eliminate tobacco-related morbidity and mortality.

This Special Issue of International Journal of Environmental Research and Public Health (IJERPH) focuses on emerging trends in combustible tobacco and vaping product use. New research papers and reviews are welcome to this issue. Other manuscript types accepted include methodological papers, position papers, brief reports, and commentaries. Studies examining longitudinal trends in prevalence of cigarette use, vaping product use, and poly-product use among adolescents and adults are of primary interest. In addition, we welcome papers examining differences in product use prevalence, future use intentions, health risk perceptions, and reasons for product use across countries, population subgroups, and/or policy environments. Manuscripts addressing the impact of the COVID-19 pandemic on changes in use and perceived health risks of nicotine/tobacco products are also of interest.

We will accept manuscripts from different disciplines including but not limited to: epidemiology, health policy, psychology, sociology, and geography. Surveillance studies, clinical studies, intervention studies, and other types of studies will be considered. Here are some examples of topics that could be addressed in this Special Issue:

Trends in prevalence of cigarette smoking and vaping product use
- Among adolescents
- Among adults
- Among current or former cigarette smokers
Differences in trajectories of combustible tobacco and vaping product use across population subgroups
- By sex/gender
- By racial/ethnic group
- By mental or physical health status
- By socioeconomic status
Longitudinal associations between frequency of cigarette and heated tobacco product use
Differences in prevalence of heated tobacco product use across countries
Adolescents’ perceptions of the relative health risks of cigarettes, e-cigarettes, and heated tobacco products
Factors associated with “switching” from cigarettes to e-cigarettes or heated tobacco products among adult cigarette smokers

Disclaimer: We will not accept research funded in part or full by any tobacco companies in this Special Issue. For more details, please check: https://www.mdpi.com/1660-4601/15/12/2831/htm.

Dr. Michael Stephen Dunbar
Dr. Joan S. Tucker
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Tobacco use trends
cigarettes
e-cigarettes
smoking
vaping
heated tobacco products
poly-tobacco use
harm reduction and minimization
modified risk tobacco products

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Published Papers (11 papers)

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Editorial

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4 pages, 248 KiB

Open AccessEditorial

Introduction to the Special Issue “Emerging Trends in Combustible Tobacco and Vaping Product Use”

by Michael S. Dunbar and Joan S. Tucker

Int. J. Environ. Res. Public Health 2022, 19(9), 4992; https://doi.org/10.3390/ijerph19094992 - 20 Apr 2022

Cited by 1 | Viewed by 1615

Abstract

Tobacco use remains a leading cause of preventable death and disease worldwide [...] Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

Research

Jump to: Editorial, Other

10 pages, 5330 KiB

Open AccessArticle

Differences in Young Adults’ Perceptions of and Willingness to Use Nicotine Pouches by Tobacco Use Status

by Erin A. Vogel, Jessica L. Barrington-Trimis, Afton Kechter, Alayna P. Tackett, Fei Liu, Steve Sussman, Caryn Lerman, Jennifer B. Unger, Chanita Hughes Halbert, Benjamin W. Chaffee and Adam M. Leventhal

Int. J. Environ. Res. Public Health 2022, 19(5), 2685; https://doi.org/10.3390/ijerph19052685 - 25 Feb 2022

Cited by 21 | Viewed by 6344

Abstract

Oral nicotine pouches may appeal to young adult current nicotine/tobacco users interested in alternative forms of nicotine that lack pulmonary exposure, but may also appeal to young adult non-users of nicotine/tobacco products. We used data from a 2020 remote digital survey of an ongoing cohort study of young adults from Southern California (aged 19–23) to examine differences in pouch perceptions and use willingness across nicotine/tobacco use statuses. Participants who had never used nicotine pouches (N = 1167) viewed text/imagery from mass-marketed pouch packaging and advertising, then completed measures of willingness to use nicotine pouches, pouch harm perceptions, and hypothetical choice of cigarettes or e-cigarettes over pouches. Willingness to use pouches was significantly higher among non-combustible only (33.8%), combustible only (29.3%), and dual (43.9%) users than non-users (14.7%). Overall, 49.1% of participants were uncertain whether pouches were less harmful than cigarettes and 52.4% were uncertain whether pouches were less harmful than e-cigarettes. Relative harm perceptions did not significantly differ by tobacco use status. Those using non-combustible products (either alone or as part of dual use with combustible tobacco) had greater odds than non-users of reporting that they would use e-cigarettes over nicotine pouches. By contrast, all tobacco product user groups reported greater odds than non-users that they would use cigarettes over pouches. In sum, a sizable minority of young adults might be willing to try using nicotine pouches, but most are uncertain about the relative harm of pouches. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

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11 pages, 329 KiB

Open AccessArticle

Trends in Overall and Menthol Market Shares of Leading Cigarette Brands in the USA: 2014–2019

by Erin J. Miller Lo, William J. Young, Ollie Ganz, Eugene M. Talbot, Richard J. O’Connor and Cristine D. Delnevo

Int. J. Environ. Res. Public Health 2022, 19(4), 2270; https://doi.org/10.3390/ijerph19042270 - 17 Feb 2022

Cited by 10 | Viewed by 3128

Abstract

Many factors can shift cigarette brand preference, and surveillance is an important tactic to inform regulatory strategy. The objective of this study was to identify shifts in top brands’ overall and menthol market share from 2014 to 2019. We used data from the National Survey on Drug Use and Health public use datasets, which are a nationally representative, cross-sectional survey of people aged 12+ in the USA. In our analysis of top brands, we accounted for consumption patterns and computed the percent change in market share for each brand. We observed that overall market share declined for nearly all brands, though top moderately priced brands gained share. Half of the top brands with menthol styles grew in menthol market share. We observed three primary shifts in the cigarette market: brands that gained the most menthol market share were brands with both menthol and non-menthol in their product lineups; menthol contributed substantially to discount brands’ market share increases; the two premium brands that employed “natural” descriptors experienced increased market share. Research should continue to focus on trends that influence cigarette market share, as the cigarette market in the USA is likely to look very different in five years than it does today. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

14 pages, 323 KiB

Open AccessArticle

Sociodemographic Factors Associated with Adolescents’ and Young Adults’ Susceptibility, Use, and Intended Future Use of Different E-Cigarette Devices

by Shivani M. Gaiha, Poonam Rao and Bonnie Halpern-Felsher

Int. J. Environ. Res. Public Health 2022, 19(4), 1941; https://doi.org/10.3390/ijerph19041941 - 9 Feb 2022

Cited by 11 | Viewed by 3052

Abstract

Numerous studies have identified sociodemographic factors associated with susceptibility, ever-use and past-30-day use of e-cigarettes, including JUUL. However, it remains unknown which sociodemographic factors are associated with adolescents’ and young adults’ (AYA) use of the entire spectrum of different types of e-cigarette devices (e.g., disposables, pod/cartridge-based, and other e-cigarettes, like mods or tanks). The aim of this study was to examine the relationship between sociodemographic factors and use, future use intent and susceptibility to use different e-cigarette device types. We conducted a national online survey using a convenience sample of 13–24-year-olds, 50:50 e-cigarette ever- to never-users and sex and race/ethnicity balanced per the U.S. Census (n = 4351). Sociodemographic factors were not associated with ever use of disposables among AYAs or generally with intent to use e-cigarette devices in the future. However, sociodemographic factors were related to the use of pod/cartridge-based and other e-cigarette devices. LGBTQ+ AYAs were more likely to use pod/cartridge-based devices and to be susceptible to using all device types compared to other AYAs. Young adults, males, and other/multiracial non-Hispanic AYAs were more likely to report past-30-day-use of all devices and AA/Black non-Hispanic AYAs were more likely to report past-30-day use of pod/cartridge-based and other devices compared to former users. AA/Black non-Hispanic AYAs were more likely to be susceptible to using all devices and other/multiracial non-Hispanic AYAs were susceptible to using other devices (compared to White non-Hispanic AYAs). AYAs under 21 who were former users were more likely to intend using other devices in the future compared to AYAs 21 years or above. These findings may inform targeted prevention efforts to curb the growing popularity of different devices among AYAs. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

12 pages, 1222 KiB

Open AccessArticle

#NicotineAddictionCheck: Puff Bar Culture, Addiction Apathy, and Promotion of E-Cigarettes on TikTok

by Makayla Morales, Alexis Fahrion and Shannon Lea Watkins

Int. J. Environ. Res. Public Health 2022, 19(3), 1820; https://doi.org/10.3390/ijerph19031820 - 5 Feb 2022

Cited by 21 | Viewed by 10459

Abstract

This study aimed to classify and delineate types of user-generated content about the disposable e-cigarette Puff Bar shared on the popular video-based social media platform TikTok. We qualitatively analyzed 148 popular TikTok videos collected in July 2020. During an iterative process of data reduction and thematic analysis, we categorized videos by overarching genres and identified emergent themes. Young adults were engaged at all stages of the research process. Together, videos were viewed over 137 million times on TikTok. Seven genres of Puff Bar content emerged: skits and stories, shared vaper experiences, videos to show off, product reviews, product unboxing, promotion of Puff Bar, and crafts. Videos depicted Puff Bar users’ apathy about addiction and a lack of concern of the health effects of e-cigarette use. Additionally, Puff Bar promotion content from underground retailers was extensive and some targeted underage persons. Qualitative analysis of social media content can richly describe emerging online culture and illuminate the motivations of adolescent and young adult e-cigarette use. Social media can facilitate new product adoption; comprehensive e-cigarette regulation and enforcement can counteract these effects by closing loopholes through which new products emerge. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

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11 pages, 699 KiB

Open AccessArticle

Longitudinal Associations of Substance Use Risk Profiles with the Use of Alternative Tobacco Products and Conventional Smoking among Adolescents

by Marieke Hiemstra, Andrea Rozema, Maria Jansen, Hans van Oers and Jolanda Mathijssen

Int. J. Environ. Res. Public Health 2021, 18(24), 13248; https://doi.org/10.3390/ijerph182413248 - 16 Dec 2021

Cited by 4 | Viewed by 3419

Abstract

Although personality is associated with the onset of substance use (i.e., conventional smoking, alcohol use, and cannabis use) during adolescence, it is unclear whether personality traits are also associated with the onset of use of alternative tobacco products (ATPs), i.e., electronic cigarettes, shisha-pens, and water pipes. This study examines whether personality traits are associated with the onset of use of both conventional cigarettes and ATPs. Longitudinal data (baseline and 18-month follow-up) were used. The sample consisted of 1114 non-user adolescents (mean age = 13.36, SD = 0.93, 56% female) at baseline. To measure personality traits, the Substance Use Risk Profile Scale was used with four subscales: anxiety sensitivity, hopelessness, sensation seeking, and impulsivity. Structural equation models were conducted using Mplus 7.3. Results showed that both hopelessness and sensation seeking were associated with the onset of use of e-cigarettes and conventional cigarettes. Further, sensation seeking and impulsivity were associated with the onset of use of shisha-pens and water pipes. In conclusion, to prevent adolescents from using ATPs and/or conventional cigarettes, it is important to take their personality traits into account. More research on other (shared) risk factors and on more advanced stages of ATP use is needed before effective prevention strategies can be developed. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

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12 pages, 320 KiB

Open AccessArticle

Trends in Exclusive, Dual and Polytobacco Use among U.S. Adults, 2014–2019: Results from Two Nationally Representative Surveys

by Delvon T. Mattingly, Luis Zavala-Arciniega, Jana L. Hirschtick, Rafael Meza, David T. Levy and Nancy L. Fleischer

Int. J. Environ. Res. Public Health 2021, 18(24), 13092; https://doi.org/10.3390/ijerph182413092 - 11 Dec 2021

Cited by 22 | Viewed by 4104

Abstract

Although increases in the variety of tobacco products available to consumers have led to investigations of dual/polytobacco use patterns, few studies have documented trends in these patterns over time. We used data from the 2014/2015 and 2018/2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) and the 2015–2019 National Health Interview Survey (NHIS) to estimate trends in the following use patterns: exclusive use of cigarettes, electronic nicotine delivery systems (ENDS), other combustibles (cigars/cigarillos/little filtered cigars and traditional pipes/hookah), and smokeless tobacco (four categories); dual use (two product groups) of each product group with cigarettes (three categories); polyuse with cigarettes (all four product groups; one category); and dual/polyuse without cigarettes (one category). We estimated trends in product use patterns overall and by age, sex, and race/ethnicity using two-sample tests for differences in linear proportions. From 2014/2015 to 2018/2019, exclusive ENDS use increased, whereas cigarettes and ENDS dual use decreased. Furthermore, polyuse with cigarettes decreased, whereas dual/polyuse without cigarettes increased, with trends varying by age, sex, and race/ethnicity. Our findings suggest that patterns of dual/polyuse with and without cigarettes have changed in recent years, indicating the need for further surveillance of concurrent tobacco product use patterns. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

12 pages, 487 KiB

Open AccessArticle

Perceived Change in Tobacco Use and Its Associated Factors among Older Adults Residing in Rohingya Refugee Camps during the COVID-19 Pandemic in Bangladesh

by Sabuj Kanti Mistry, ARM Mehrab Ali, Uday Narayan Yadav, Md. Nazmul Huda, Saruna Ghimire, Md. Ashfikur Rahman, Sompa Reza, Rumana Huque and Muhammad Aziz Rahman

Int. J. Environ. Res. Public Health 2021, 18(23), 12349; https://doi.org/10.3390/ijerph182312349 - 24 Nov 2021

Cited by 2 | Viewed by 3346

Abstract

This study explored the perceived change in tobacco use during the COVID-19 pandemic and its associated factors among older adults residing in Rohingya refugee camps, also referred to as Forcibly Displaced Myanmar Nationals in Bangladesh. The study followed a cross-sectional design and was conducted in October 2020 among 416 older adults aged 60 years and above. A purposive sampling technique was applied to identify eligible participants, and face-to-face interviews were conducted using a pre-tested semi-structured questionnaire to collect the data. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic. Binary logistic regression models determined the factors associated with the perceived change in tobacco use. More than one in five participants (22.4%) were current tobacco users, of whom 40.8% reported a perceived increase in tobacco use during the COVID-19 pandemic. Adjusted analysis revealed that participants who were concerned about COVID-19 had significantly (p < 0.05) lower odds of perceived increase in tobacco use (aOR = 0.22, 95% CI: 0.06–0.73), while older adults who were overwhelmed by COVID-19 (aOR = 0.26, 95% CI: 0.06–1.18) and communicated less frequently with others during the pandemic than before (aOR = 0.19, 95% CI: 0.03–1.20) had marginally significantly (p < 0.1) lower odds of perceived increase in tobacco use during this pandemic. Relevant stakeholders, policymakers, and practitioners need to focus on strengthening awareness-raising initiatives as part of an emergency preparedness plan to control tobacco use during such a crisis period. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

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10 pages, 307 KiB

Open AccessArticle

“It’s Cool, Modifying and All, but I Don’t Want Anything Blowing Up on Me:” A Focus Group Study of Motivations to Modify Electronic Nicotine Delivery Systems (ENDS)

by Zachary B. Massey, Robert T. Fairman, Victoria Churchill, David L. Ashley and Lucy Popova

Int. J. Environ. Res. Public Health 2021, 18(22), 11735; https://doi.org/10.3390/ijerph182211735 - 9 Nov 2021

Cited by 8 | Viewed by 2457

Abstract

Introduction: Modifications to electronic nicoti ne delivery systems (ENDS) can pose health risks to users. This study explored users’ motivations for modifying ENDS devices and how perceived risks of modifications influenced modification behaviors as product availability and device characteristics changed over time. Method: We conducted nine focus groups (February–June 2020) with 32 current ENDS users (18+, used ENDS in the past 30 days, and had been using ENDS for more than 2 months). Results: Participants primarily modified ENDS devices to improve their experiences, such as experimenting with flavor, controlling nicotine levels, or using cannabis products with ENDS. Another reason for modifying was routine maintenance to ensure a satisfactory experience, including maintaining coils and keeping batteries charged. The broader availability of ENDS products shifted modification behaviors over time, with newer devices making some modifications (e.g., coil replacement) easier and making more intricate modifications (e.g., building coil from scratch) less common. Participants were aware of modification dangers and cited perceived risk as the reason for avoiding certain modifications, such as battery alterations. Conclusions: Modifications of ENDS are ongoing and evolving among users and should be considered by the Food and Drug Administration (FDA) and other regulatory decision-makers as product authorization reviews are conducted and product standards are developed. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

8 pages, 294 KiB

Open AccessArticle

Cigarette Relighting: A Series of Pilot Studies Investigating a Common Yet Understudied Smoking Behavior

by Carolyn J. Heckman, Olivia A. Wackowski, Rohit Mukherjee, Dorothy K. Hatsukami, Irina Stepanov, Cristine D. Delnevo and Michael B. Steinberg

Int. J. Environ. Res. Public Health 2021, 18(12), 6494; https://doi.org/10.3390/ijerph18126494 - 16 Jun 2021

Cited by 3 | Viewed by 3619

Abstract

Background: The act of extinguishing, saving, and later relighting unfinished cigarettes is a common yet understudied behavior that may have implications for tobacco treatment and health. Methods: This paper presents four pilot studies investigating various aspects of this topic: (1) the prevalence of relighting among NJ and NY Quitline callers (n = 20,984); (2) the prevalence and correlates of relighting in two national surveys (n = 1008, n = 1018); (3) a within-subject (n = 16) laboratory experiment comparing cigarettes smoked per day and exhaled carbon monoxide when relighting and not relighting cigarettes; and (4) a national survey of tobacco treatment providers’ (n = 150) perceptions of relighting. Results: Relighting was found to be common (approximately 45% of smokers), and associated with lower socioeconomic status, heavier smoking and nicotine dependence, greater smoking-related concerns, as well as high levels of exhaled carbon monoxide. Providers noted the potential importance of relighting but reported that they do not regularly incorporate it into their assessment or tobacco treatment planning. Conclusions: These findings address a major research gap in the emerging research on this common behavior. Future research is needed to better understand the potential implications of relighting for policies and clinical practices related to tobacco cessation and health. Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

Other

Jump to: Editorial, Research

8 pages, 445 KiB

Open AccessBrief Report

E-Cigarettes Use Behaviors in Japan: An Online Survey

by Shihoko Koyama, Takahiro Tabuchi and Isao Miyashiro

Int. J. Environ. Res. Public Health 2022, 19(2), 892; https://doi.org/10.3390/ijerph19020892 - 14 Jan 2022

Cited by 9 | Viewed by 5232

Abstract

Electronic cigarette (e-cigarette) use has become increasingly widespread throughout the world, including in Japan. However, little is known about how e-cigarettes are used in Japan, a country with heavy restrictions on nicotine-containing e-liquids and/or vaping products. This study examined e-cigarette use (e-cigarette use duration, frequency of use, device type, electrical resistance, nicotine use, favorite e-liquid flavors) among users in Japan, through an online survey using a web-based self-reported questionnaire which included questions about sex, age, combustible cigarette and heated tobacco product (HTP) use behaviors. Of 4689 e-cigarettes users analyzed, 93.5% were men and 52.9% had been using e-cigarettes for 1–3 years. Over 80% used e-cigarettes every day; 62.3% used nicotine liquid, and half of the nicotine liquid users used nicotine salt. The most popular liquid flavor was fruit (prevalence: 68.1%), followed by tobacco (prevalence: 48.4%). While 50.9% were e-cigarette single users, 35.2% were dual users (e-cigarettes and cigarettes or HTPs) and 13.8% were triple user (e-cigarettes, cigarettes and HTPs). This is the first comprehensive survey of Japanese e-cigarette users and our finding suggest more than half use nicotine liquid, although e-cigarettes containing nicotine liquid have been prohibited by the Pharmaceutical Affairs Act since 2010 in Japan. The study also showed 49.1% of participants used cigarettes and/or HTPs concurrently (dual or triple users). Full article

(This article belongs to the Special Issue Emerging Trends in Combustible Tobacco and Vaping Product Use)

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