This study extends the current literature by using cognitive interviews to test ENDS assessment questions in a sample of young adults, a population at elevated risk for ENDS use. Problems encountered when answering ENDS use questions underscore the need to develop easily understood ENDS questions that allow for quantification of ENDS use. Future research examining the nature of ENDS product types and different levels of user experience will yield valuable assessment tools for researchers and tobacco control professionals.

Purpose: The purpose of this study was to compare characteristics of usual JUUL users versus other electronic nicotine delivery systems (ENDS) users, examine differences in reasons for use and perceptions across ENDS user groups, and identify significant correlates of usual JUUL use. Methods: This study used data from 510 young adult ENDS users (ages 18e29 years) from Wave 7 (Spring 2018) of the Marketing and Promotions Across Colleges in Texas Project (Project M-PACT). Chi-Square analyses, independent t-tests, and mixed-effects logistic regression analyses were conducted to identify factors associated with usual JUUL use. Four separate regression analyses were conducted based on independent variables of interest; all models included demographics and ENDS/other tobacco use behaviors as covariates. Results: Compared with other ENDS users, usual JUUL users were more likely to be male, younger, smoke cigarettes, reported a higher socioeconomic status (SES), used ENDS on more days in the past 30 days, and reported nicotine "hit" as a reason for use. Usual JUUL users had a higher prevalence of perceiving JUUL/pod vapes as addictive compared with other ENDS users, although perceived addictiveness was not significant in the multivariable models nor were the cessation and dependence measures different between ENDS user groups. Conclusions: Results highlight concerns about the dual use of JUUL and cigarettes and raise additional concerns about the high nicotine concentration of JUUL. Future longitudinal research is needed to determine if usual JUUL users are more likely to develop symptoms of nicotine dependence compared with other ENDS users.

Objectives-We examined patterns of tobacco and electronic cigarette (e-cigarette) use among college students. Differences in sociodemographic characteristics between non-users of these products and 4 mutually exclusive groups of tobacco/e-cigarette users were assessed. Differences in cigarette cessation attempts and dependence between exclusive cigarette smokers and users of cigarettes and at least one alternative tobacco product also were examined. Human Subjects StatementApproval to conduct this research was provided by the University of Texas at Austin IRB [Protocol Number: 2013-06-0034]. Conflict of Interest StatementAll authors of this article declare they have no conflicts of interest. HHS Public AccessAuthor manuscript Am J Health Behav. Author manuscript; available in PMC 2017 July 01. Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptMethods-Participants were 5468 18-29 year-old students from 24 colleges in Texas who completed an online survey.Results-Multiple-product use was more prevalent than single-product use. All 4 current tobacco/e-cigarette-user groups were more likely than non-users to be men and older. College students who were younger when they smoked their first cigarette, and those reporting ever needing a cigarette, were more likely to be multiple-product users than cigaretteonly users. There were no group differences in cigarette cessation attempts or any other variables.Conclusions-Using multiple products is associated with some indicators of dependence, but does not seem to aid or deter college students' smoking cessation attempts. Longitudinal research is needed given that transitions in tobacco/e-cigarette use continue throughout young adulthood. Keywordscigarette cessation attempts; cigarette dependence; non-cigarette products; polytobacco use; tobacco use among young adults Whereas cigarette use in the United States (US) has been declining, 1 the use of alternative products, such as cigars and electronic nicotine delivery systems (ENDS, also referred to as e-cigarettes) has been increasing. 2,3 Young adults have the highest prevalence of use of alternative products. 4 Approximately 22% of 18-34 year-olds reported ever using at least one non-combustible product (ie, e-cigarettes, chewing tobacco/dip/snuff, snus or dissolvables) in 2012 and 52% reported ever using at least one combustible non-cigarette product (ie, cigars, pipes, little cigars/cigarillos, bidis, or hookah). 5 Young adults also are more likely than older adults to be concurrent users of multiple products, 6,7 and data from the National Survey on Drug Use and Health showed that multiple-tobacco product use increased significantly from 2002 to 2012 for 18-25 year-olds, but not for those over 25. 8 One group of young adults at elevated risk for multiple-product use is college students. 9,10 The college years, and young adulthood more generally, are characterized by instability and change in multiple domains of behavior, including tobacco and e-cigarette use 11 (hereafter referred to as tobacco...

Sexual minority (SM) young adults, such as those who identify as lesbian, gay, or bisexual (LGB), have well documented smoking disparities compared to heterosexual young adults. However, no studies have simultaneously tested the role of three risk factors (depressive symptoms, recalling tobacco marketing in bars, and cigarette-related social norms) to explain SM tobacco use disparities. Longitudinal structural equation modeling was used to explore if the association between SM identity and past 30-day cigarette smoking one year later was mediated by these three risk factors. Starting in fall 2015, three surveys were administered every 6 months to 3,972 young adult college students. Surveys assessed SM identity, depressive symptoms, tobacco marketing in bars, normative perceptions of cigarettes, and tobacco use behaviors. Greater depressive symptoms, recalling more tobacco marketing in bars, and more accepting cigarette-related social norms were each hypothesized to explain a unique portion of the association between SM identity and subsequent cigarette use. SM young adults reported higher prevalence of cigarette use, depressive symptom scores reflecting elevated risk for major depressive disorder, and more accepting cigarette-related social norms than their heterosexual peers. Results indicated that only cigarette-related social norms mediated the association between SM identity and subsequent past 30-day smoking, while controlling for depressive symptoms, recalling tobacco marketing in bars, sociodemographic factors, and previous tobacco use. Findings reflect a need for tailored tobacco control messaging that shift the more accepting cigarette-related norms of SM young adults, as doing so may ultimately lead to decreased smoking for this high-risk subgroup.

This study extends the current literature by finding that younger, female, and racial/ethnic minorities have greater odds of flavored cigar use than their peers. Flavored cigars have characteristics that appeal to members of these populations, which can contribute to their long-term use and potential for addiction.