Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use

Wagener, Theodore L.; Leavens, Eleanor L S; Mehta, Toral; Hale, Jessica; Shihadeh, Alan; Eissenberg, Thomas; Halquist, Matthew S.; Brinkman, Marielle C.; Johnson, Amanda L.; Floyd, Evan L.; Ding, Kai; Hage, Rachel El; Salman, Rola

doi:10.1136/tobaccocontrol-2019-055509

Cited by 16 publications

(10 citation statements)

References 25 publications

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“…Evidence suggests that hookah tobacco users experience withdrawal symptoms, alter behavior to access hookah tobacco, and have a hard time quitting despite wanting to quit [9]. Additionally, although flavorings like fruit and candy present substantial risks of health harm and addiction [24,25], flavored tobacco products including hookah tobacco are perceived to be more appealing, better tasting, and less dangerous than non-flavored products [26]. A longitudinal analysis using PATH data demonstrated the role of flavors in initiation and use: approximately 66% of young adult hookah users reported that their first use was flavored, and initiation with flavored hookah tobacco was prospectively associated with current use [27].…”

Section: Introductionmentioning

confidence: 99%

Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults

Phan

Villanti

Leshner

et al. 2020

IJERPH

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Young adults’ hookah tobacco use is fueled by misperceptions about risks, appealing flavors, and social use. We developed and pretested public education messages to prevent and reduce hookah tobacco smoking among young adults. We used a two (user status: current hookah user, susceptible never user) by two (risk content: health harms or addiction) by three (message theme: harms/addiction risk alone, harms/addiction risk flavors, or harms/addiction risk social use) design with two messages/condition (n = 12 total messages). Young adults aged 18–30 (N = 713) were randomized to 1 of 12 messages and completed measures assessing message receptivity, attitudes, and negative emotional response. Harms messages were associated with greater receptivity (p < 0.001), positive attitudes (p < 0.001), and negative emotional response (p < 0.001) than addiction messages. Messages with harm or addiction content alone were associated with greater receptivity than social use-themed messages (p = 0.058). Flavor-themed messages did not differ in receptivity from harm or addiction content alone or social use-themed messages. Messages about the health harms of hookah tobacco use resonate more with young adults than addiction risk messages. Social use-themed messages produce the lowest receptivity. These findings can guide population-based approaches to communicate hookah tobacco risks to young adults.

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Section: Introductionmentioning

confidence: 99%

Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults

Phan

Villanti

Leshner

et al. 2020

IJERPH

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“…This specifically applies to adolescents who experience conflicts within their families and turn to smoke to satisfy their psychological needs [15]. Waterpipe is becoming more popular among adolescents [6,77] since they are more tempted to smoke water pipes because of the different flavors [78], and the lower knowledge and worse attitude about waterpipe and its harmful effects [79][80][81][82].…”

Section: Discussionmentioning

confidence: 99%

Parental divorce and smoking dependence in Lebanese adolescents: the mediating effect of mental health problems

et al. 2022

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Background Lebanon has the highest prevalence estimates among Middle Eastern countries and Arab women regarding cigarette smoking, with 43% of men and 28% of women involved in such trends. Marital disruption is a tremendous source of irritability and discomfort that may hinder a child's healthy development, creating perturbing distress and increasing disobedience that may exacerbate smoking addiction. Additionally, Lebanese adolescents are inflicted by high emotional and economic instability levels, rendering increased susceptibility to distress and propensity to engage in addictive behavior. This study aims to investigate the association between parental divorce and smoking dependence among Lebanese adolescents, along with exploring the potential mediating effect of mental health disorders of such correlation. Methods A total of 1810 adolescents (14 and 17 years) enrolled in this cross-sectional survey-based study (January-May 2019). Linear regressions were conducted to check for variables associated with cigarette and waterpipe dependence. PROCESS v3.4 model 4 was used to check for the mediating effect of mental health disorders between parental divorce and smoking dependence. Results Higher suicidal ideation and having divorced parents vs living together were significantly associated with more cigarette and waterpipe dependence. Higher anxiety was significantly associated with more waterpipe dependence. Insomnia and suicidal ideation played a mediating role between parental divorce and cigarette/waterpipe dependence. Conclusion Our results consolidate the results found in the literature about the association between parental divorce and smoking addiction and the mediating effect of mental health issues. We do not know still in the divorce itself or factors related to it are incriminated in the higher amount of smoking in those adolescents. Those results should be used to inspire parents about the deleterious effect of divorce on their children to lower their risk of smoking addiction. Further longitudinal studies are needed to better understand the complexity of such associations and to see whether the divorce experience by itself or the factors that accompany it are involved in the increased smoking addiction among adolescents.

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“…Behavioral Intentions for continued use will be assessed by asking participants how likely they are to: 1) try the product again, 2) purchase the product for regular use, and 3) use the product regularly if this were the only e-cigarette available. Response options will range from 1 “extremely unlikely” to 7 “extremely likely” [ 28 ]. The intensity of sensory attributes will be assessed by asking participants to rate the intensity of: 1) throat hit, 2) smoothness, 3) harshness, 4) sweetness, and 5) bitterness of each e-cigarette on the General Labeled Magnitude Scale (gLMS) [ 23 , 29 ].…”

Section: Methodsmentioning

confidence: 99%

The sweet spot study—Developing e-liquid product standards for nicotine form and concentration to improve public health: Protocol for a randomized, double-blinded, crossover study

Cho,

Brinkman,

Hinton

et al. 2023

PLoS ONE

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Objectives E-cigarettes pose significant risks to youth, but smokers may benefit from switching to e-cigarettes by reducing their exposure to toxicants, which creates a challenge for the Food and Drug Administration (FDA) in regulating e-cigarettes to protect population health. This study aims to develop e-liquid product standards for nicotine form and concentration that reduce the appeal of e-cigarettes to young people while keeping e-cigarettes available as a safer alternative for smokers. Design and participants A single-visit, double-blinded, randomized crossover design will be used to examine the effects of e-liquids with varying fractions of free-base nicotine (5%, 25%, 45%, 65%, 85%) among a sample of 66 young adult EC users and 66 older adult smokers, across ecologically valid total nicotine concentrations (20 mg or 50 mg/mL). Interventions and outcomes A 2-puff session will be conducted to test each of the 10 e-liquids in randomly assigned sequences, followed by a 10-minute washout period and participant ratings on appeal and sensory attributes such as throat hit and harshness, as well as behavioral intentions for continued use. Generalized linear mixed models will be used to determine a free-base nicotine level that has limited or no appeal to young adult e-cigarette users while remaining acceptable to smokers. Conclusions This study will provide the FDA with scientific evidence regarding the effect of product standards that mandate a minimum threshold for the fraction of free-base nicotine. Trial registration The study is registered on clinicaltrials.gov under the identifier NCT05864586.

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Impact of flavors and humectants on waterpipe tobacco smoking topography, subjective effects, toxicant exposure and intentions for continued use

Cited by 16 publications

References 25 publications

Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults

Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults

Parental divorce and smoking dependence in Lebanese adolescents: the mediating effect of mental health problems

The sweet spot study—Developing e-liquid product standards for nicotine form and concentration to improve public health: Protocol for a randomized, double-blinded, crossover study

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