Purpose of Review: E-cigarettes are available in a variety of flavors not found in traditional tobacco products (i.e., "nontraditional flavors"), which is a commonly-cited reason for e-cigarette use. This review examines the prevalence of nontraditional-flavored e-cigarette use, mechanisms through which flavorings enhance product appeal, use of nontraditional-flavored e-cigarettes for smoking cessation, and differences in these findings between youth and adults.Recent Findings: Nontraditional-flavored e-cigarettes are used at e-cigarette initiation by the majority of youth. These flavors enhance the appeal of e-cigarettes by creating sensory perceptions of sweetness and coolness and masking the aversive taste of nicotine. Use of nontraditionalflavored e-cigarettes is higher among youth and young adults (vs. older adults) and among nonsmokers (vs. combustible cigarette smokers).
Introduction
California implemented multiple strategies, such as a Tobacco 21 law and compliance checks, to reduce high rates of youth e-cigarette use. However, the prevalence of use among underage youth and young adults continues rising. Little is known about how underage individuals obtain e-cigarettes.
Methods
We conducted structured qualitative interviews with 61 young adult (18-25 years old) vapers in the Los Angeles, CA area between June 2018 and June 2019. Interviews were comprehensive and designed to elicit information on participants’ thoughts, feelings, and experiences related to vaping. We queried participants on where and how they obtained vaping products, and participants discussed their experiences accessing products while under the legal age for sale. Directed content analysis was used to analyze interviews.
Results
Four concepts emerged: (1) Early experimentation of e-cigarettes with peers often occurred in a school setting, (2) Continued use of e-cigarettes commonly obtained through peer sales, (3) Inconsistent implementation of age restrictions at in-person retailers and (4) at online retailers. Participants had peers purchase products on their behalf and frequented in-person and online retailers with few to no age verification processes. Few participants faced challenges when purchasing products from retailers.
Conclusions
The current study’s findings offer insight into where and how underage individuals obtain vaping products despite restrictions to prevent them from doing so. Participant accounts of mixed ease of underage purchasing in person and online suggest retailer education is needed, along with additional research to inform more effective policies to reduce underage access to vaping products.
Implications
Despite legal age restrictions, e-cigarettes remain accessible to underage individuals, but specific strategies that underage youth utilize to evade legal age restrictions are largely unknown. We found that participants often accessed vaping products for the first time at school. Sales between peers were common, and participants also reported frequenting in-person retailers that inconsistently enforced age restrictions. Many participants reported little to no age verification online, though some believed online age verification measures were increasingly difficult to surpass. Knowledge of strategies underage youth utilize to access e-cigarettes can inform enforcement efforts.
Background: Pre-exposure prophylaxis (PrEP) for HIV prevention is indicated for people who inject drugs (PWID), yet most studies exclude PWID. This study examines factors associated with PrEP awareness and willingness, and identifies perceived barriers to PrEP among PWID.Methods: PWID were interviewed in Los Angeles and San Francisco, CA from 2016 to 2018. We analyzed data from self-reported HIV-negative participants who had injected drugs within the past 6 months (n=469). Questions on PrEP included awareness, willingness, barriers, and uptake. Multiple logistic regression models of factors associated with awareness of, and willingness to, take PrEP were developed. Descriptive statistics on perceived PrEP barriers are reported.Results: Among HIV-negative PWID, 40% were aware of PrEP, 59% reported willingness to take PrEP, and 2% were currently taking PrEP. In multivariable analysis, PrEP awareness was associated with study site and sexual minority status, higher educational attainment, and HIV testing in the last 6 months. Willingness to take PrEP was associated with self-reported risk (paying sex partner in the last 6 months, sharing drug paraphernalia, and being injected by another PWID) and perceived HIV risk. The most common perceived barriers to PrEP were copays, concerns about increase in HIV or sexually transmitted risk with PrEP, and concerns about reduction of medication efficacy without daily use.
Conclusion:PrEP awareness among PWID remains inadequate. Willingness to take PrEP was moderate and was most desired by PWID who engaged in high-risk behaviors. Interventions to increase PrEP awareness and willingness, and to facilitate PrEP uptake among PWID are needed.
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