Impact of e-cigarette characteristics and marketing on tobacco use and health: A longitudinal study among U.S. youth and adults

项目摘要/摘要 电子烟的使用迅速增加，特别是在年轻人和年轻人中。吸引人的味道是一种 年轻人开始并继续使用电子烟的主要原因。年轻的成年非吸烟者 可能开始使用非烟草和非薄荷醇(NTM)口味的电子烟，而不是烟草和 薄荷醇(TM)的味道与现在的吸烟者相比，这令人担忧，因为电子烟的使用导致 香烟启蒙仪式。电子烟的类型也可能导致电子烟使用量的激增。进阶 新一代(开放系统)设备提供尼古丁的速度比老一代(封闭系统)设备更快，并且可以 迅速减轻戒断症状。了解电子烟的口味和设备类型是否以及如何影响 烟草使用行为是制定应对电子烟流行的监管活动的基础 香烟的使用。此外，电子烟一直在积极地营销，使用的策略吸引了 年轻人。年轻人接触电子烟广告会导致电子烟的启动和更大的 敏感度。但其潜在的机制尚未得到充分的探索。一种潜在的机制是 广告曝光减少了人们对电子烟的感知危害和成瘾性，这反过来又导致电子烟- 香烟的萌发和易感性。最后，电子烟的使用会增加心肺疾病的风险。 和牙周病。然而，证据主要来自横断面数据或 相对较小的样本。为了填补知识空白，我们将使用来自 烟草与健康人口评估(PATH)研究旨在实现三个具体目标：(1)确定 电子烟的口味和类型对青少年(12-17岁)和年轻人(18-34岁)使用电子烟的影响 老年人(35岁及以上)。我们将进行具有倾向性的多变量Logistic回归 评分权重以评估电子烟口味(NTM与TM)和类型(开放式与封闭式)的总体影响 电子烟使用频率)。我们将进行因果调解分析，以检验假设， 与TM口味相比，NTM口味电子烟的使用减少了对电子烟的伤害和成瘾感觉， 这会导致更频繁地使用电子烟；(2)确定接触电子烟广告对 电子烟的启动、使用频率和敏感度。与目标1类似，我们将执行多元逻辑分析 回归评估电子烟广告曝光对结果的影响，并进行因果分析 中介分析，以评估电子烟的伤害和成瘾感的中介效果；以及(3) 确定电子烟的使用对心血管、呼吸和牙周健康的影响，并比较 对不同类型的烟草使用者的影响(例如，专门使用电子烟的人从不吸烟， 专属电子烟使用者(前吸烟者、双重吸烟者和只吸烟者)。调查结果来自 我们的研究将与涉及电子烟口味、产品设计的监管决策直接相关 和营销做法，并将为未来应对电子烟使用流行病的干预措施提供信息。

PROJECT SUMMARY/ABSTRACT E-cigarette use has increased rapidly, particularly among youth and young adults. The appealing flavors are a primary reason for young people to initiate and continue to use e-cigarettes. Young adult nonsmokers are more likely to initiate e-cigarette use with non-tobacco and non-menthol (NTM) flavors rather than tobacco and menthol (TM) flavors compared to current smokers, which is worrisome because e-cigarette use leads to cigarette initiation. The types of e-cigarette may also contribute to the surge in e-cigarette use. Advanced generation (open-system) devices deliver nicotine faster than old generation (closed-system) devices and can rapidly reduce withdrawal symptoms. Understanding if and how e-cigarette flavors and device types affect tobacco use behaviors is fundamental to developing regulatory activities that address the epidemic of e- cigarette use. In addition, e-cigarettes have been marketed aggressively using strategies that are appealing to young people. Youth exposure to e-cigarette advertising leads to e-cigarette initiation and greater susceptibility. But the underlying mechanism has not been fully explored. A potential mechanism is that advertising exposure reduces perceived harms and addictiveness of e-cigarettes, which in turn, lead to e- cigarette initiation and susceptibility. Last, e-cigarette use is associated with elevated risks for cardiopulmonary and periodontal diseases. However, evidence has been predominantly from cross-sectional data or on relatively small samples. To fill the knowledge gap, we will use longitudinal data (Waves 1-4) from the Population Assessment of Tobacco and Health (PATH) Study to accomplish three specific aims: (1) identify the impact of e-cigarette flavors and types on e-cigarette use among youth (12-17 years), young adults (18-34 years), and older adults (35 years and older). We will perform multivariate logistic regression with propensity score weights to assess the overall impact of e-cigarette flavors (NTM vs. TM) and types (open vs. closed- system) on e-cigarette use frequency. We will perform causal mediation analysis to test the hypothesis that, compared to TM flavors, NTM flavored e-cigarette use reduces harm and addiction perceptions of e-cigarettes, which lead to more frequent e-cigarette use; (2) determine the impact of exposure to e-cigarette advertising on e-cigarette initiation, use frequency, and susceptibility. Similar to Aim 1, we will perform multivariate logistic regression to assess the effect of e-cigarette advertising exposure on the outcomes, and conduct causal mediation analyses to assess the mediating effect of harm and addiction perceptions of e-cigarettes; and (3) identify the effect of e-cigarette use on cardiovascular, respiratory, and periodontal health, and compare the effects among different types of tobacco users (e.g., exclusive e-cigarette users never cigarette smokers, exclusive e-cigarette users former cigarette smokers, dual users, and cigarette-only smokers). Findings from our study will be directly relevant to regulatory decision-making that address e-cigarette flavors, product design and marketing practices, and will inform future interventions that tackle the epidemic of e-cigarette use.