A Mixed Methods EMA Assessment of Cognition and Behavior among New ENDS Users

产品说明：烟草产品的范围正在扩大，新的不燃产品越来越受欢迎，即使吸烟流行率的下降速度减缓或停滞。电子烟或电子尼古丁输送系统（ENDS）是这些新兴的不可燃产品中最流行的。随着销售的快速增长和更有效的肺部输送装置的开发，ENDS可能会在未来的烟草市场中发挥越来越大的作用。关于导致或维持ENDS使用的认知和行为知之甚少。吸烟者可能会使用ENDS来破坏吸烟限制（即桥梁“产品”），以减少感知的吸烟危害，或戒烟，可能会延迟使用已证明的治疗方法。关于ENDS的日常使用者，大部分信息仅限于回顾性调查和白色男性的便利样本。我们的研究表明，黑人吸烟者比白色吸烟者更不可能尝试或使用ENDS，这可能是由于与ENDS相关的更大程度的感知伤害，对薄荷醇的偏好或文化规范。然而，随着Lorillard烟草公司（纽波特卷烟制造商）最近购买Blue（c）电子烟，由于该公司向黑人吸烟者销售薄荷ENDS，种族对ENDS的差异采用可能不会继续下去。因此，研究所有吸烟者，包括黑人和薄荷醇吸烟者，如何使用有效的创新研究方法体验和启动ENDS是及时和关键的。我们的研究代表了第一步，了解直接的环境背景和心理相关性与ENDS启动在薄荷醇和非薄荷醇吸烟者有兴趣尝试ENDS。我们的观察性研究包括三周的同步生态瞬时评估（EMA）和深入访谈数据收集，随后进行30天的随访电话联系，以评估香烟和ENDS的使用。我们将从华盛顿，华盛顿特区市区招募100名每日吸烟者。由于80%的黑人吸烟者更喜欢薄荷醇香烟，因此将样本按薄荷醇使用和种族（非西班牙裔白色和非西班牙裔黑人）分为四组（每组n=25），使我们能够从文化规范/预期中分解薄荷醇偏好对ENDS启动的影响。参与者将使用我们现有的EMA数据收集系统，在为期三周的研究过程中收集有关烟草使用行为的数据。在第1周，参与者将收集关于其通常吸烟模式的基线数据。在第2周，我们将为参与者提供一周的ENDS供应和每日至少三次使用产品的说明。在第三周，我们将补充参与者的ENDS供应，并鼓励参与者使用他们认为合适的产品。参与者还将在每周结束时参加半结构化的深入访谈。第1周的访谈将侧重于EMA数据收集经验的过程评估，而第2周和第3周的访谈将侧重于ENDS相关的认知、期望和规范如何随着ENDS的使用和对产品的熟悉程度的增加而演变。访谈的定性数据将补充定量EMA数据，以研究基于社会认知理论的环境，认知和行为驱动ENDS启动之间的相互作用。个人内部目标将检查环境背景（例如，位置、他人的存在），心理状态（例如，情绪）和烟草依赖（例如，#21453;的个人使用。探索性次要目的包括对种族和薄荷醇偏好对ENDS启动的影响进行人与人之间的检查，并通过比较我们的形成性人与人之间EMA结果与深度访谈的病例间结果，探索分层变量之间的相互作用。这种探索性的R21将有助于新兴的ENDS研究领域，通过确定促进ENDS启动的潜在机制和预测ENDS的使用模式，包括ENDS是否取代或与香烟同时使用，或用作减少危害或戒烟的辅助手段。这项研究将是第一个检查ENDS使用的黑人和薄荷醇吸烟者，两个亚群的利益中心烟草产品和烟草控制一般。该研究将支持未来的R 01资助申请，以更密切地研究ENDS启动后的因果途径和长期行为结果。

DESCRIPTION: The universe of tobacco products is expanding, with new noncombustible products gaining popularity even as the reduction in prevalence of cigarette smoking slows or stalls. E-cigarettes, or Electronic Nicotine Delivery Systems (ENDS), are the most prevalent of these emerging noncombustible products. With sales increasing rapidly and more efficient pulmonary delivery devices under development, ENDS are likely to play an increasing role in the future tobacco market. Little is known about the cognitions and behaviors leading to or sustaining ENDS use. Smokers may use ENDS to subvert smoking restrictions (i.e. a bridge "product"), to reduce perceived smoking harms, or for cessation, possibly delaying use of proven treatments. With respect to daily ENDS users, the majority of information is limited to retrospective surveys and convenience samples of White males. Our research suggests Black smokers are less likely than White smokers to try or to use ENDS, perhaps due to a greater degree of perceived harm associated with ENDS, a preference for menthol, or cultural norms. However, with the recent purchase of Blue(c) e-cigarettes by Lorillard Tobacco Company (maker of Newport cigarettes), differential adoption of ENDS by race may not continue as the company markets mentholated ENDS to Black smokers. Thus, it is timely and critical to study how all smokers, including Blacks and menthol smokers, experience and initiate ENDS using valid, innovative research methods. Our research represents a first step towards understanding the immediate environmental contexts and psychological correlates associated with ENDS initiation in menthol and non-menthol smokers interested in trying ENDS. Our observational study features three weeks of concurrent ecological momentary assessment (EMA) and in-depth interview data collection, followed by a 30-day follow-up telephone contact to assess cigarette and ENDS use. We will enroll 100 daily cigarette smokers from the Washington, D.C. metro area. Since 80% of Black smokers prefer menthol cigarettes, the sample will be stratified into four groups (n=25 per group) by menthol use and race (non-Hispanic White and non-Hispanic Black), allowing us to disaggregate the influence of menthol preference from cultural norms/expectancies on ENDS initiation. Participants will use our preexisting EMA data collection system to collect data on tobacco use behaviors over the course of the three-week study. In Week 1, participants will collect baseline data on their usual smoking pattern. In Week 2, we will provide participants with a week's supply of ENDS and instructions to use the products at least three times daily. In Week 3, we will replenish participants' ENDS supply and encourage participants to use the products as they see fit. Participants will also take part in a semi-structured in-depth interview at the end of each week. Week 1 interviews will focus on a process evaluation of the EMA data collection experience, while the Week 2 and 3 interviews will focus on how ENDS-associated cognitions, expectancies and norms evolve with ENDS use and increasing familiarity with the product. Qualitative data from the interviews will complement the quantitative EMA data to examine the interplay between environment, cognitions, and behaviors driving ENDS initiation based on Social Cognitive Theory. Within-person aims will examine the longitudinal relationship between environmental context (e.g., location, presence of others), psychological state (e.g., mood), and tobacco dependence (e.g., craving) on an individual's ENDS use. Exploratory secondary aims include a between- person examination of the effects of race and menthol preference on ENDS initiation and will allow for exploration of interaction effects between the stratification variables by comparing our formative between-person EMA findings with between-case findings from in-depth interviews. This exploratory R21 will contribute to the emerging field of ENDS research by identifying potential mechanisms promoting ENDS initiation and predicting ENDS patterns of use, including whether ENDS displace or are used concurrently with cigarettes, or are used as aids to reduce harm or quit smoking. This study will be the first to examine ENDS use among Black and menthol smokers, two subpopulations of interest to the Center for Tobacco Products and tobacco control in general. The research will support a future R01 grant submission to more closely examine the causal pathways and long term behavioral outcomes following ENDS initiation.