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

描述：烟草产品的范围正在扩大，尽管吸烟流行率的下降放缓或停滞不前，但新的不可燃产品越来越受欢迎。电子烟，或电子尼古丁传递系统(END)，是这些新兴的不可燃产品中最普遍的。随着销量的快速增长和更高效的肺部给药装置的开发，END可能会在未来的烟草市场发挥越来越大的作用。人们对导致或维持终端使用的认知和行为知之甚少。吸烟者可能会使用Ends来颠覆吸烟限制(即一种桥梁“产品”)，以减少人们认为的吸烟危害，或者是为了戒烟，可能会推迟使用经过验证的治疗方法。关于日常终端用户，大多数信息仅限于白人男性的回溯性调查和便利样本。我们的研究表明，黑人吸烟者比白人吸烟者不太可能尝试或使用END，这可能是因为与END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(Newport香烟制造商)最近购买了Blue(C)电子烟，随着该公司向黑人吸烟者销售薄荷烟，按种族区分End的做法可能不会继续下去。因此，研究包括黑人和薄荷醇吸烟者在内的所有吸烟者如何使用有效的创新研究方法体验和发起目标是及时和关键的。我们的研究是朝着了解与薄荷醇和非薄荷醇吸烟者对尝试结束感兴趣的末端启动相关的直接环境背景和心理相关性迈出的第一步。我们的观察性研究包括三周的同步生态瞬时评估(EMA)和深度访谈数据收集，然后是30天的跟踪电话联系，以评估香烟和终端的使用情况。我们将从华盛顿大都会地区招募100名每天吸烟的人。由于80%的黑人吸烟者更喜欢薄荷醇香烟，样本将根据薄荷醇的使用和种族(非西班牙裔白人和非西班牙裔黑人)分成四组(每组n=25)，使我们能够分解文化规范/预期的薄荷醇偏好对末端起始的影响。参与者将使用我们现有的EMA数据收集系统来收集为期三周的研究过程中烟草使用行为的数据。在第一周，参与者将收集他们通常吸烟模式的基线数据。在第二周，我们将为参与者提供一周的产品供应和使用说明，每天至少使用三次。在第三周，我们将补充参与者的产品供应，并鼓励参与者按他们认为合适的方式使用产品。参与者还将在每个周末参加一次半结构化的深度面试。第一周的访谈将集中于对EMA数据收集体验的过程评估，而第二周和第三周的访谈将重点关注与END相关的认知、预期和规范如何随着END的使用和对产品的日益熟悉而演变。访谈的定性数据将补充定量的EMA数据，以基于社会认知理论检验环境、认知和行为之间的相互作用，驱动目标启动。个人内部目标将研究环境背景(例如，位置、他人的存在)、心理状态(例如，情绪)和对个人最终用途的烟草依赖(例如，渴望)之间的纵向关系。探索性次要目标包括对种族和薄荷醇偏好对末端起始的影响的人与人之间的检查，并将允许通过比较我们形成的人与人之间的EMA发现与来自深度访谈的病例间的发现来探索层化变量之间的交互影响。这一探索性的R21将通过识别促进END起始的潜在机制和预测END的使用模式，包括END是否取代香烟或与香烟同时使用，或被用作减少危害或戒烟的辅助工具，为END研究的新兴领域做出贡献。这项研究将第一次检查黑色和薄荷醇吸烟者的终端使用情况，这是烟草产品中心和烟草控制中心普遍关注的两个亚群。这项研究将支持未来的R01拨款申请，以更仔细地检查EDS启动后的因果路径和长期行为结果。

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.