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Youth Smoking

Tobacco Use in the USA

http://www.falloncountyextra.com/2016/04/29/tobacco-use-usa/

Submitted by Julie Russell, RN Tobacco Prevention Specialist Carter, Fallon, & Powder River County

• High school students who are current (past month) smokers: 15.7 percent (boys: 16.4 percent, girls: 15.0 percent); over 2.6 million
• High school males who currently use smokeless tobacco: 14.7 percent (girls: 2.9 percent)
• Kids (under 18) who try smoking for the first time each day: 2,500+
• Kids (under 18) who become new regular, daily smokers each day: 580
• Kids (3-11) exposed to secondhand smoke: 40.6 percent (Black: 67.9 percent White: 37.2 percent)
• Packs of cigarettes consumed by kids each year: approx. 540 million (nearly $1.2 billion per year in sales revenue)
• Adults in the USA who are current smokers: 16.8 percent (men: 18.8 percent, women: 14.8 percent); approx. 40 million
• Adults in the USA who smoke daily: 12.9 percent Deaths & Disease in the USA from Tobacco Use
• People who die each year from cigarette smoking and exposure to secondhand smoke: approx. 480,000+
• Kids under 18 alive today who will ultimately die from smoking (unless smoking rates decline): 5.6 million
• People in the USA who currently suffer from smoking-caused illness: 16 million+ Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined, with thousands more dying from spit tobacco use. Of all the kids who become new smokers each year, almost a third will ultimately die from it. In addition, smokers lose a decade of life because of their smoking. For every person who dies from smoking, at least 30 more are suffering from serious smoking-caused disease and disability. Tobacco-Related Monetary Costs in the USA
• Total annual public and private health care expenditures caused by smoking: approx. $170 billion – annual federal and state government smoking-caused Medicaid payments: $39.6 billion (Federal share: $22.5 billion per year. States’ share: $17.1 billion) – Federal government smoking-caused Medicare expenditures each year: $45.0 billion – Other federal government tobacco-caused health care costs (e.g. through VA health care): $23.8 billion
• Annual health care expenditures solely from secondhand smoke exposure: $6.03 billion. Not included above are costs from smokeless or spit tobacco use or pipe/cigar smoking.
• Productivity losses caused by smoking each year: $151 billion (only includes costs from productive work lives shortened by smoking-caused death. Not included: costs from smoking-caused disability during work lives, smoking-caused sick days, or smoking-caused productivity declines when on the job.) Other non-healthcare costs from tobacco use include residential and commercial property losses from smoking -caused fires, tobacco related cleaning and maintenance, and expenditures through Social Security Survivors Insurance for kids who have lost at least one parent from a smoking-caused death.
• Taxpayers yearly fed/state tax burden from smoking-caused government spending: US$960 per household
• Smoking-caused health costs and productivity losses per pack sold in USA (low estimate):US $19.16 per pack
• Average retail price per pack in the USA (including sales tax): US$5.96 Tobacco Industry Advertising & Political Influence
• Annual tobacco industry spending on marketing its products nationwide: US$9.5 billion ($25+ million each day) Research studies have found that kids are three times as sensitive to tobacco advertising than adults and are more likely to be influenced to smoke by cigarette marketing than by peer pressure; and that a third of underage experimentation with smoking is attributable to tobacco company advertising and promotion.
• Tobacco company PAC contributions to federal candidates, 2014 election cycle: More than US$1.8 million
• Tobacco industry expenditures lobbying Congress in 2014: US$22.0 million.

Heterogeneity in the measurement and reporting of outcomes in studies of electronic cigarette use in adolescents

A systematic analysis of observational studies

http://tobaccocontrol.bmj.com/content/early/2016/04/29/tobaccocontrol-2015-052881.short?g=w_tobaccocontrol_ahead_tab

Abstract

Objective

To examine consistency between cross-sectional studies of conventional and electronic cigarette use among adolescents in terms of the measurement, analysis and reporting of parameters.

Design

A systematic analysis of cross-sectional studies of conventional and electronic cigarette use in adolescents, to identify measured and reported parameters.

Data sources

Studies examining use of electronic and conventional cigarette use in adolescents were identified by searching the SCOPUS database in August 2015.

Study selection

The selection criteria for studies were: cross-sectional studies, in English, on e-cigarette use in adolescents. Two reviewers independently selected relevant studies from the search. 60 abstracts were identified, from which 31 papers were eligible for review (23 unique studies).

Data extraction

Measured and reported parameters were identified and tabulated. These included the prevalence of cigarette and/ or electronic cigarette use, and the definitions of terms. Data were extracted independently by two reviewers.

Data synthesis

With regards basic parameters of ‘ever’ or ‘current’ use of electronic or conventional cigarettes, there were 31 unique measured parameters across 23 studies. Of 16/23 studies in which authors collected information on dual current use, prevalence was reported in 11/16, with six different definitions of ‘dual use’.

Conclusions

There are substantial differences in measurement and reporting of parameters across observational studies of electronic and conventional cigarette use in adolescents. These studies are at risk of reporting bias, and results are difficult to interpret. A core outcome set that should be measured and reported in all observational studies is required, using structured consensus techniques.

Early symptoms of nicotine dependence among adolescent waterpipe smokers

http://tobaccocontrol.bmj.com/content/early/2016/04/25/tobaccocontrol-2015-052809.short?g=w_tobaccocontrol_ahead_tab

Abstract

Background

Although waterpipe smoking is increasingly popular among youth and can lead to nicotine dependence (ND), no studies have documented how ND develops in waterpipe smokers. We examined the emerging symptoms of ND among adolescent waterpipe smokers in Lebanon.

Methods

Individual confidential interviews were used to evaluate ND in 160 waterpipe smokers and 24 cigarette smokers from a sample of 498 students enrolled in 8th and 9th grades in Lebanon.

Results

Among waterpipe smokers, 71.3% endorsed at least one Hooked on Nicotine Checklist (HONC) symptom and 38.1% developed the full syndrome of ND (≥3 criteria using the International Classification of Diseases, 10th revision). The early symptoms of ND among waterpipe smokers were craving (25%), feeling addicted (22.5%), and failed quit attempts (14.3%). Among those who reached the respective milestones, median tobacco use when the first HONC symptom emerged was 7.5 waterpipes/month with smoking frequency of 6 days/month; the median tobacco use for the full syndrome of ND was 15 waterpipes/month with smoking frequency of 15 days/month. Among those who had already reached these milestones, the first HONC symptom appeared 10.9 months after the initiation of waterpipe smoking, and the full syndrome of ND was reached at 13.9 months. In addition, cues such as seeing or smelling waterpipe, and the café environment triggered craving in most waterpipe smokers with symptoms of ND.

Conclusions

Symptoms of ND develop among adolescent waterpipe smokers at low levels of consumption and frequency of use. Craving for nicotine triggered by waterpipe-specific cues is reported even at this young age. Waterpipe-specific ND prevention and intervention programmes for youth are needed.

Effects of plain package branding and graphic health warnings on adolescent smokers in the USA, Spain and France

http://tobaccocontrol.bmj.com/content/early/2016/04/18/tobaccocontrol-2015-052583.short?g=w_tobaccocontrol_ahead_tab

Abstract

Objective

The purpose of this study is to provide an experimental test of the effects of plain pack branding and graphic health warnings (GHWs) in three different countries for an important and vulnerable population, that is, adolescents who are experimenting with smoking.

Methods

The effects of plain pack branding (logo present, logo absent), and graphic visual warning level (absent, low, medium, high) are studied experimentally for their impact on adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting in the USA, Spain and France. A total of 1066 adolescents who were experimenting with smoking served as participants in the study. A quota sample produced 375 respondents in the USA, 337 in Spain and 354 in France.

Results

Overall findings indicate that the GHWs were effective in impacting adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting. The plain pack effects were not as strong, yet reduced craving, increased fear, and decreased pack feelings for all three samples combined, and for US adolescent smokers individually, irrespective of the GHWs. For French adolescent smokers, plain pack effects for craving were limited to low/moderate GHW levels. For Spanish adolescent smokers, plain pack feeling effects were limited to the absence of the GHWs.

Conclusions

The results show that plain packs can independently strengthen the more instantaneous, direct effects (short of quitting thoughts) found with the GHWs. Yet, the plain pack results were attenuated for Spanish and French adolescent smokers, who are currently exposed to GHWs.

Youth and Tobacco Use

If smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness. That’s about 1 of every 13 Americans aged 17 years or younger alive today.1

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/

Background

Preventing tobacco use among youth is critical to ending the tobacco epidemic in the United States.

  • Tobacco use is started and established primarily during adolescence.2,3
    • Nearly 9 out of 10 cigarette smokers first tried smoking by age 18, and 99% first tried smoking by age 26.1,3
    • Each day in the United States, more than 3,200 youth aged 18 years or younger smoke their first cigarette, and an additional 2,100 youth and young adults become daily cigarette smokers.3
  • Flavorings in tobacco products can make them more appealing to youth.4
    • In 2014, 73% of high school students and 56% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.

Estimates of Current Tobacco Use Among Youth

middle-high-tobacco-us

Cigarette smoking has declined among U.S. youth in recent years, but the use of some other tobacco products has increased.5

Cigarettes

  • From 2011 to 2015, current cigarette smoking declined among middle and high school students.5,6
    • About 2 of every 100 middle school students (2.3%) reported in 2015 that they smoked cigarettes in the past 30 days—a decrease from 4.3% in 2011.
    • About 9 of every 100 high school students (9.3%) reported in 2015 that they smoked cigarettes in the past 30 days—a decrease from 15.8% in 2011.

Electronic cigarettes

  • Current use of electronic cigarettes increased among middle and high school students from 2011 to 2015.5,6
    • About 5 of every 100 middle school students (5.3%) reported in 2015 that they used electronic cigarettes in the past 30 days—an increase from 0.6% in 2011.
    • 16 of every 100 high school students (16.0%) reported in 2015 that they used electronic cigarettes in the past 30 days—an increase from 1.5% in 2011.

Hookahs

  • From 2011 to 2015, current use of hookahs increased among middle and high school students.5,6
    • 2 of every 100 middle school students (2.0%) reported in 2015 that they had used hookah in the past 30 days—an increase from 1.0% in 2011.
    • About 7 of every 100 high school students (7.2%) reported in 2015 that they had used hookah in the past 30 days—an increase from 4.1% in 2011.

Smokeless Tobacco

  • In 20155:
    • Nearly 2 of every 100 middle school students (1.8%) reported current use of smokeless tobacco.
    • 6 of every 100 high school students (6.0%) reported current use of smokeless tobacco.

All Tobacco Product Use

  • In 2015, about 7 of every 100 middle school students (7.4%) and about 25 of every 100 high school students (25.3%) used some type of tobacco product.5
  • In 2013, nearly 18 of every 100 middle school students (17.7%) and nearly half (46.0%) of high school students said they had ever tried a tobacco product.7

Use of multiple tobacco products is prevalent among youth.3

  • In 2015, about 3 of every 100 middle school students (3.3%) and 13 of every 100 high school students (13.0%) reported use of two or more tobacco products in the past 30 days.5
  • In 2013, more than 31 of every 100 high school students (31.4%) said they had ever tried two or more tobacco products.7

Youth who use multiple tobacco products are at higher risk for developing nicotine dependence and might be more likely to continue using tobacco into adulthood.7

Notes:
“Current use” is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days.

Tobacco product types include cigarettes, cigars, hookahs, snus, smokeless tobacco, pipes, bidis, dissolvable tobacco, and electronic cigarettes.

“Use” is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days. †"Any tobacco product" includes cigarettes, cigars, smokeless tobacco (including chewing tobacco, snuff, dip, snus, and dissolvable tobacco), tobacco pipes, bidis, hookah, and electronic cigarettes. §Where percentages are missing, sample sizes were less than 50 and thus considered unreliable.

“Use” is determined by respondents indicating that they have used a tobacco product on at least 1 day during the past 30 days.
†”Any tobacco product” includes cigarettes, cigars, smokeless tobacco (including chewing tobacco, snuff, dip, snus, and dissolvable tobacco), tobacco pipes, bidis, hookah, and electronic cigarettes.
§Where percentages are missing, sample sizes were less than 50 and thus considered unreliable.

Factors Associated With Youth Tobacco Use

Factors associated with youth tobacco use include the following:

  • Social and physical environments;2,8
    • The way mass media show tobacco use as a normal activity can promote smoking among young people.
    • Youth are more likely to use tobacco if they see that tobacco use is acceptable or normal among their peers.
    • High school athletes are more likely to use smokeless tobacco than their peers who are non-athletes.9
    • Parental smoking may promote smoking among young people.
  • Biological and genetic factors2
    • There is evidence that youth may be sensitive to nicotine and that teens can feel dependent on nicotine sooner than adults.
    • Genetic factors may make quitting smoking more difficult for young people.
    • A mother’s smoking during pregnancy may increase the likelihood that her offspring will become regular smokers.
  • Mental health: There is a strong relationship between youth smoking and depression, anxiety, and stress.2
  • Personal perceptions: Expectations of positive outcomes from smoking, such as coping with stress and controlling weight, are related to youth tobacco use.2
  • Other influences that affect youth tobacco use include:2,8
    • Lower socioeconomic status, including lower income or education
    • Lack of skills to resist influences to tobacco use
    • Lack of support or involvement from parents
    • Accessibility, availability, and price of tobacco products
    • Low levels of academic achievement
    • Low self-image or self-esteem
    • Exposure to tobacco advertising

Reducing Youth Tobacco Use

National, state, and local program activities have been shown to reduce and prevent youth tobacco use when implemented together. They include the following:

  • Higher costs for tobacco products (for example, through increased taxes)2,10,11
  • Prohibiting smoking in indoor areas of worksites and public places2,10,11
  • Raising the minimum age of sale for tobacco products to 21 years, which has recently emerged as a potential strategy for reducing youth tobacco use11
  • TV and radio commercials, posters, and other media messages targeted toward youth to counter tobacco product advertisements2,10
  • Community programs and school and college policies and interventions that encourage tobacco-free environments and lifestyles2,10
  • Community programs that reduce tobacco advertising, promotions, and availability of tobacco products2,10

Some social and environmental factors have been found to be related to lower smoking levels among youth. Among these are:2

  • Religious participation
  • Racial/ethnic pride and strong racial identity
  • Higher academic achievement and aspirations

Continued efforts are needed to prevent and reduce the use of all forms of tobacco use among youth.

References

  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2016 Apr 14].
  2. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 1994 [accessed 2016 Apr 14].
  3. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012 [accessed 2016 Apr 14].
  4. Centers for Disease Control and Prevention. Flavored Tobacco Product Use Among Middle and High School Students—United States, 2014. Morbidity and Mortality Weekly Report, 2015;64(38):1066–70 [accessed 2016 Apr 14].
  5. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2011–2015. Morbidity and Mortality Weekly Report, 2016;65(14):361–7 [accessed 2016 Apr 14].
  6. Centers for Disease Control and Prevention. Tobacco Product Use Among Middle and High School Students—United States, 2011 and 2012. Morbidity and Mortality Weekly Report, 2013;62(45):893–7 [accessed 2016 Apr 14].
  7. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2013. Morbidity and Mortality Weekly Report, 2014;63(45):1021–6 [accessed 2016 Apr 14].
  8. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000 [accessed 2016 Apr 14].
  9. Centers for Disease Control and Prevention. Combustible and Smokeless Tobacco Use Among High School Athletes—United States, 2001–2013. Morbidity and Mortality Weekly Report, 2015;64(34):935–9 [accessed 2016 Apr 14].
  10. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2016 Apr 14].
  11. King BA, Jama AO, Marynak KL, Promoff GR. Attitudes Toward Raising the Minimum Age of Sale for Tobacco Among U.S. Adults. American Journal of Preventive Medicine 2015. E-pub ahead of print: DOI: http://dx.doi.org/10.1016/j.amepre.2015.05.012 [accessed 2016 Apr 14].

 

Recall, appeal and willingness to try cigarettes with flavour capsules: assessing the impact of a tobacco product innovation among early adolescents

http://tobaccocontrol.bmj.com/content/early/2016/04/08/tobaccocontrol-2015-052805.short?g=w_tobaccocontrol_ahead_tab

Abstract

Background

Use of flavour capsule varieties (FCVs) of cigarettes has rapidly increased in many countries. Adolescents are attracted to flavours; yet, surprisingly, no quantitative study has explored adolescents’ perceptions of these products.

Objective

To characterise the appeal of FCVs for young adolescents in Mexico.

Methods

In 2015, surveys were conducted with a representative sample of Mexican middle school students (n=10 124; ages 11–16 years; mean 12.4 years). Students viewed and rated packs for FCVs and non-FCVs from major brands (Marlboro, Camel, Pall Mall), with brand names removed. For each pack, students were asked to write the brand name (ie, brand recall), to evaluate pack attractiveness, and to indicate the pack they were most interested in trying (including a ‘none’ option). Logistic generalised estimating equation (GEE) models regressed brand recall, pack attractiveness and interest in trying on brand and FCV (yes vs no), controlling for sociodemographics and smoking risk factors.

Results

Marlboro regular, Camel regular, Camel light and Pall Mall FCVs were most often recalled (25%, 17%, 9%, 8%). Packs for Pall Mall FCVs and Camel FCVs were most often rated as very attractive (13%, 9%, respectively) and of interest for trial (22%, 13%) along with Marlboro regular (14%). In GEE models, FCVs were independently associated with greater attractiveness (adjusted OR (AOR)=1.83, 95% CI 1.72 to 1.94) and interest in trying (AOR=1.74, 95% CI 1.54 to 1.96). Perceived pack attractiveness was also independently associated with greater interest in trying (AOR=5.63, 95% CI 4.74 to 6.68).

Conclusions

FCVs appear to be generating even greater appeal among young adolescents than established non-FCVs in dominant brand families.

Has Boston’s 2011 cigar packaging and pricing regulation reduced availability of single-flavoured cigars popular with youth?

http://tobaccocontrol.bmj.com/content/early/2016/04/12/tobaccocontrol-2015-052619.short?g=w_tobaccocontrol_ahead_tab

Abstract

Objective

We evaluated retailer compliance with a cigar packaging and pricing regulation in Boston, Massachusetts, enacted in February 2012, and the regulation’s impact on availability of single cigars.

Methods

Grape-flavoured Dutch Masters (DM) single-packaged cigars were examined as market indicator. At quarterly intervals from October 2011 to December 2014, availability and price of DM single cigars were observed through professional inspector visits to tobacco retailers in Boston (n=2232) and 10 comparison cities (n=3400). Differences in price and availability were examined between Boston and the comparison cities and across Boston neighbourhoods.

Results

The mean price of DM single cigars sold in Boston increased from under $1.50 in 2011 to above $2.50 in 2014, consistent with regulation requirements. Rates of retailer compliance reached 100% within 15 months postpolicy enactment based on observed price, and 97% at 30 months postenactment based on final sale prices. There was a 34.5% net decrease in the percentage of Boston retailers selling single cigars from 2011 to 2014. The number of Boston neighbourhoods with 3 or more retailers selling single cigars per 100 youth residents decreased from 12 in 2011 to 3 in 2014. No change in price or per cent of retailers selling single cigars was observed in the comparison cities in the same period.

Conclusions

Retailers throughout Boston are in compliance with the regulation. The regulation has been effective in reducing levels and disparities in availability of flavoured single cigars popular with youth across Boston neighbourhoods, regardless of socioeconomic status and racial/ethnic composition.

CVS launches $50m campaign to bring up first tobacco-free generation

http://www.retaildive.com/news/cvs-launches-50m-campaign-to-bring-up-first-tobacco-free-generation/415500/

Dive Brief:

  • CVS Health, the largest drugstore retailer in the U.S., launched “Be the First,” a $50 million, five-year effort to help curb tobacco use, which it notes is the leading preventable cause of disease and death in the U.S.
  • “Be the First” is aimed at young people, including elementary school-age kids, because youth tobacco use is rising, with nearly a quarter of high schoolers using tobacco products of some kind, according to the Centers for Disease Control and Prevention.
  • The initiative includes comprehensive education, advocacy, tobacco control and healthy behavior programming in partnership with other organizations, including the American Cancer Society and the National Urban League, that work on tobacco use cessation and prevention.

Dive Insight:

When it announced in early 2014 that it would cease sales of tobacco, the drugstore chain knew it was leaving behind $2 billion in business, but CVS president and CEO Larry Merlo said at the time that “the sale of tobacco products is inconsistent with our purpose.”

Indeed, CVS is in the midst of a hard pivot to become more of an all-around provider of healthcare and medical services in addition to its traditional pharmacy and health and beauty retail business. The chain counts among its executive ranks a physician with a public health degree, Chief Medical Officer Troyen A. Brennan, M.D., M.P.H.

“We are at a critical moment in our nation’s efforts to end the epidemic of tobacco use that continues to kill more people than any other preventable cause of death, and threatens the health and well-being of our next generation,” Brennan said in a statement. “Ensuring our youth stay tobacco-free requires increased education and awareness of healthy behaviors. We’re partnering with experts across the public health community who have established best practices to help prevent tobacco use. And, by establishing more public-private partnerships to implement these strategies more aggressively, we can help increase the number of people leading tobacco-free lives and move us one step closer to delivering the first tobacco-free generation.”

There’s no doubt that this initiative is in keeping with CVS’s health focus. But the move could also have the benefit of eating into its rivals’ bottom line. Although CVS has sought to encourage other drugstore retailers to follow in its footsteps by ending tobacco sales, none has so far, despite their own forays into medical services.

CVS last month reported Q4 earnings of $1.5 billion or $1.34 per share, meeting expectations from the street. The retailer also reported Q4 revenue of $41.15 billion, beating expectations of $41.01 billion. Retail sales rose 12.5% to $19.9 billion, about half of which stemmed from its acquisition last year of drug distribution company Omnicare.

FDA Reveals First Wave of E-Cig, Tobacco Study

Results show little evidence of consistent electronic cigarette use

http://www.cspnet.com/category-news/tobacco/articles/fda-reveals-first-wave-e-cig-tobacco-study

CHICAGO — Last week’s Society for Research on Nicotine and Tobacco Conference included numerous tobacco and nicotine-related presentations, most notably select data from the first wave of the U.S. Food and Drug Administration (FDA) and National Institute of Health’s Population Assessment of Tobacco and Health (PATH) study.

“E-cigs were a big topic in the PATH study, along with many other presentations, as the regulatory and scientific communities try to get a better grasp of the implications from this innovation, Vivien Azer, a tobacco analyst at the New York-based Cowen Group, wrote in a research note.

PATH is a longitudinal study, first mandated in 2011, in order for the FDA to gain a better understanding of tobacco use. About 46,000 U.S. tobacco and nontobacco users participate, all above the age of 12. The first wave of the study began in 2013 and was presented at the conference.

The data suggested regular use of electronic cigarettes is still very low, with just 5.5% of adults and 3.1% of 12- to 17-year-olds having used e-cigs in the past month. Azer added that daily e-cig users make up a very small percentage of these 30-day e-cig users.

“In fact, among current adult e-cig users, more than 40% had only used an e-cig less than three times in the past 30 days,” she said. “We believe [this] points to the continued lack of consumer adoption of the products.”

The data also seemed to dispute claims that e-cigs act as a gateway to other tobacco products, as the majority of e-cig users in the study were already consumers of other tobacco products.

“Overall, 15.9% of adult current e-cig users were nicotine naive,” Azer said. “While a smaller 8.5% of daily e-cig users had not previously used tobacco.”

In terms of flavors in e-cigs and other tobacco products, PATH researchers found the use of flavors was most prominent in e-cig users across the board. For e-cig consumers 25 years and older, 63% reported using flavors, while 85% of e-cig users ages 12 to 17 reported using flavors (though Azer noted this youth group exhibited a strong flavor preference across all tobacco categories).

Azer said the Wave 1 database is currently only available for restricted use, but full dataset will be available later this year. The second wave of data is currently being reviewed, and Wave 3 is 40% complete. PATH researchers announced last week that the study will be extended four years and will now include seven waves, with the final wave set to be completed in 2022.

“We view the extension of the study as a positive (given the agency will take time to evaluate findings from the study and could potentially push back any incremental regulations),” Azer said.

Tobacco Company Marketing to Children

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