108
E
lectronic cigarettes, or “e-cigarettes,” are de-
vices that consist of a battery-operated ele-
ment which heats a mixture of propylene gly-
col, vegetable glycerin, liquid nicotine and flavor-
ings for the user to inhale. Whereas their overall
safety, as well as their role in smoking cessation, is
the topic of ongoing debate,1 there is no doubt that
the prevalence of e-cigarette use has increased rap-
idly among all age groups.2,3 Among adolescents,
nationally-representative estimates indicate that
past 30-day use for e-cigarettes is higher than con-
ventional cigarettes, and a considerable proportion
of e-cigarette users are dual users of cigarettes.4
That is, a nontrivial number of adolescents—2.2%
of 8th graders, 4.3% of 10th graders and 7.3% of
12th graders— reported using both e-cigarettes and
cigarettes in the past 30 days.4 Several e-cigarette
product features are raising concerns about the
potential to appeal to youth. For example, charac-
teristics such as candy flavorings and easy access
have been implicated as reasons for youth experi-
mentation.5 E-cigarettes also are marketed heavily
on the Internet. A content analysis of e-cigarette
retail websites found frequent appeals to youth
such as use by celebrities, enhanced social activ-
ity, and romance.6
Adolescent Dual Product Use
Increasingly, youth who use tobacco products
are using more than one type of product.7,8 Be-
tween 2002 and 2011, rates of poly-tobacco use
increased significantly among users under age 26.9
According to estimates from the National Youth To-
bacco Survey, the majority of current tobacco us-
ers in middle and high school report use of more
than one tobacco product.10,11 Thus, use of mul-
tiple tobacco products by youth is more common
than exclusive use of one product alone. As such,
it is important to understand the correlates asso-
ciated with and characteristics of adolescent us-
ers of multiple tobacco products. To date, evidence
Maria Cooper, Post-doctoral Fellow, Kathleen R. Case, Pre-
doctoral Fellow, MeLisa R. Creamer, Faculty Associate, and
Cheryl L. Perry, Professor and Regional Dean, University of
Texas Health Science Center at Houston, School of Public
Health, Austin Regional Campus, Austin, TX. Alexandra Lou-
kas, Professor, University of Texas at Austin, Department of
Kinesiology and Health Education, Austin, TX.
Contact Dr Loukas; [email protected]
E-cigarette Dual Users, Exclusive Users
and Perceptions of Tobacco Products
Maria Cooper, PhD; Kathleen R. Case, MPH; Alexandra Loukas, PhD;
MeLisa R. Creamer, PhD; Cheryl L. Perry, PhD
Objectives: We examined differences in
the characteristics of youth non-users,
cigarette-only, e-cigarette-only, and dual
e-cigarette and cigarette users. Methods:
Using weighted, representative data, lo-
gistic regression analyses were conducted
to examine differences in demographic
characteristics and tobacco use behav-
iors across tobacco usage groups. Multi-
ple l.
CON T EMPORARYP ED I AT R I C S . C O M A U G U S T 2 0.docxmccormicknadine86
This document discusses teen vaping and the risks associated with electronic nicotine delivery systems (ENDS) like e-cigarettes. It summarizes that vaping among teens has increased dramatically in recent years, with over 3 million middle and high school students reporting e-cigarette use in 2015. The document explores the health risks of vaping nicotine and other substances to the developing brains of youth. It also discusses how targeted advertising and appealing flavors attract teens to vaping without awareness of health risks. The document calls for public awareness efforts and parental guidance to address this emerging public health issue.
This study compared characteristics and consumption patterns of dual users (combustible cigarette and e-cigarette users) to e-cigarette only users. The study found that e-cigarette only users consumed higher levels of nicotine in e-juice and more e-juice per month than dual users. Dual users consumed nicotine significantly sooner after waking than e-cigarette only users. A regression analysis indicated that higher e-juice consumption and later first nicotine exposure after waking were associated with being an e-cigarette only user. The findings provide insight into differences between dual and e-cigarette only users to inform regulation and health messaging about e-cigarettes.
This study surveyed students at a Northeastern university about hookah and e-cigarette usage. The survey found that 54% reported hookah use, 17% reported e-cigarette use, and 26% reported vapor hookah use. Students who smoked cigarettes were more likely to use e-cigarettes, vapor hookah, and smokeless tobacco. The researchers recommend an educational intervention using interactive online modules to address students' knowledge deficits about health risks.
The Impact of Trying Electronic Cigarettes on CigaretteSmoki.docxrtodd33
The Impact of Trying Electronic Cigarettes on Cigarette
Smoking by College Students: A Prospective Analysis
Erin L. Sutfin, PhD, Beth A. Reboussin, PhD, Beata Debinski, MHS, Kimberly G. Wagoner, DrPH, MPH, John Spangler, MD, MPH, and Mark Wolfson, PhD
There has been considerable growth in the
availability, marketing, sales, and use of elec-
tronic nicotine delivery systems, often referred
to as “e-cigarettes,” over the past several years.
Product sales in the United States have doubled
every year since 2008, and securities analysts
estimate the e-cigarette market is now approx-
imately a $2.5 billion industry.1 E-cigarette use
has rapidly increased among adolescents and
adults. From 2011 to 2012, rates of ever using
e-cigarettes among US middle and high school
students doubled from 3.3% to 6.8%.2 Similar
increases have been seen among US adults.3,4
Recent data suggest that e-cigarette use is
highest among young adults. Data from the
2012---2013 National Adult Tobacco Survey
show that young adults aged18 to 24 years had
a higher prevalence of e-cigarette use (8.3%)
than did the adult population as a whole
(4.2%).5 Similarly, with data from dual frame
surveys of national probability samples of
adults, McMillen et al. found that current
e-cigarette use in 2013 by young adults aged18
to 24 years (14.2%) was higher than was that
among adults aged 25 to 44 years (8.6%), 45
to 65 years (5.5%), and older than 65 years
(1.2%).4
Available data on e-cigarette use by college
students are limited, with most coming from
single-state or individual campus studies.6---9
College students are an important group to
study for several reasons. First, young adult-
hood is a period of many life transitions and
accompanying stress.10 The tobacco industry is
well aware of this vulnerable period and
recognizes it as a promising period for tobacco
use initiation and transition to addiction.11
Thus, college students are a target market for
the tobacco industry.11,12 College students are
often early adopters of novel products and
have historically been at the forefront of
societal changes in substance use that later
materialize in the general population.13 In
a cross-sectional study of college students in
North Carolina in 2009, Sutfin et al.6 found
that college students’ lifetime prevalence of
e-cigarette use was 4.9%, which was higher
than were rates of use among other adults at
the time,14,15 suggesting that college students
were early adopters of e-cigarettes.6
Additionally, there was an association be-
tween e-cigarette use and sensation seeking in
bivariate, but not multivariable, models. How-
ever, membership in Greek letter organizations
was associated with e-cigarette use in multi-
variable models. These data suggest that col-
lege students may be drawn to e-cigarettes
owing, at least in part, to their novelty. Finally,
college students are an important group to
study because they have a unique pattern of
cigarette smoking that is often marked by so.
A study of 1,300 college students found that of the 43 students whose initial nicotine exposure was from e-cigarettes, only 1 went on to smoke regular tobacco cigarettes. This contradicts claims that e-cigarettes act as a gateway to smoking. While some public health groups worry e-cigarettes could increase youth nicotine addiction, this study found that the vast majority of students who started with e-cigarettes were not currently using nicotine or tobacco products. The issue of whether e-cigarettes truly lead youth to smoking, and increased nicotine addiction, or if they can benefit public health requires more research.
This qualitative study explored college students' knowledge, attitudes, and experiences regarding nicotine-tobacco products like e-cigarettes and hookah. Three focus groups discussed: their sources of information about these products; situations and social contexts of use; differences between products; and views on health effects. Themes that emerged included use of e-cigarettes and hookah for social purposes rather than addiction, a lack of accessible information, and beliefs that these products are safer alternatives to cigarettes. The researchers recommend an educational intervention using interactive online modules to address knowledge gaps, present research-based information, and help students relate lessons to their social environments.
Society for research on nicotine and tobacco conference abstracts srnt 2014Georgi Daskalov
This document summarizes six research studies presented at the 2014 Society for Research on Nicotine and Tobacco conference. Three key findings are:
1) A study found that cytisine, a plant-derived alkaloid, was as effective as nicotine replacement therapy for smoking cessation and had fewer side effects.
2) A randomized controlled trial found that sending smokers placebo nicotine patches by mail, which induced more quit attempts, led to higher long-term smoking abstinence rates than asking smokers to obtain active patches themselves.
3) Qualitative research identified factors that prevented youth and young adult smokers and non-smokers from initiating e-cigarettes, such as health concerns, cost, and social dis
Article Review Grading Rubric
Grade Calculation: (Summary * 0.30) + (Critique * 0.5) + (Grammar/Style * 0.2) = Final Grade
Criteria Excellent
(100 points)
Very Good
(93 points)
Satisfactory
(86 points)
Needs Improvement
(79 point)
Unacceptable
(0 points)
Score
Summary:
Summarizes the
context and
content of the
selected article
Provides a very
thorough and
clear and concise
summary of the
article context and
content.
Provides a clear
and concise
summary of the
article context and
content.
Provides a clear
but shallow
summary of the
article; may be
excessively brief or
may include some
extraneous
information.
Provides a
somewhat muddled,
unclear and
rambling summary
of the article.
Provides an
unclear and
unintelligible
summary of the
article OR No
summary at all.
Critique:
Identifies and
describes your
personal reaction
to the article
Thoroughly
describes your
personal reaction
to the article;
includes
discussion of the
relevant issues
within the article.
Describes your
personal reaction
to the article;
includes a
simplistic
discussion of the
relevant issues
within the article.
Describes your
personal reaction to
the article; includes
no discussion of
the relevant issues
within the article.
Attempts to
describe your
personal reaction to
the article, but lacks
a logical flow and
reaction is muddled;
no discussion of
any relevant issues
in the article.
Provides an
unclear,
unintelligible and
illogical
description of
personal reaction
OR No description
of personal
reaction at all.
Grammar/Style:
Grammar,
mechanics, and
APA style for
references and
citations
Contains all
correct
information
regarding article
title, author name,
and article source
and date.
Consistently
contains accurate
and proper
grammatical
conventions,
spelling, and
punctuation.
Clearly and
consistently uses
proper APA
formatting for
references
/citations.
Contains all
correct info
regarding article
title, author name,
and article source
and date.
Contains accurate
and proper
grammatical
conventions,
spelling, and
punctuation most
of the time; errors
do not interfere
with paper’s
meaning.
Consistently uses
APA for citations/
references
Contains mostly
correct info
regarding article
title, author name,
and article source
and date. Contains
frequent errors in
grammatical
conventions,
spelling, and
punctuation; errors
begin to interfere
with paper’s
meaning.
Inconsistently uses
APA formatting for
citations/references
Contains incorrect
info regarding
article title, author
name, and article
source and date.
Contains numerous
errors in
grammatical
conventions,
spelling, and
punctuation;
substantially
interferes with
paper’s meaning.
Consistently fails to
use APA for
references/citations.
Response is
totally
unintelli.
CON T EMPORARYP ED I AT R I C S . C O M A U G U S T 2 0.docxmccormicknadine86
This document discusses teen vaping and the risks associated with electronic nicotine delivery systems (ENDS) like e-cigarettes. It summarizes that vaping among teens has increased dramatically in recent years, with over 3 million middle and high school students reporting e-cigarette use in 2015. The document explores the health risks of vaping nicotine and other substances to the developing brains of youth. It also discusses how targeted advertising and appealing flavors attract teens to vaping without awareness of health risks. The document calls for public awareness efforts and parental guidance to address this emerging public health issue.
This study compared characteristics and consumption patterns of dual users (combustible cigarette and e-cigarette users) to e-cigarette only users. The study found that e-cigarette only users consumed higher levels of nicotine in e-juice and more e-juice per month than dual users. Dual users consumed nicotine significantly sooner after waking than e-cigarette only users. A regression analysis indicated that higher e-juice consumption and later first nicotine exposure after waking were associated with being an e-cigarette only user. The findings provide insight into differences between dual and e-cigarette only users to inform regulation and health messaging about e-cigarettes.
This study surveyed students at a Northeastern university about hookah and e-cigarette usage. The survey found that 54% reported hookah use, 17% reported e-cigarette use, and 26% reported vapor hookah use. Students who smoked cigarettes were more likely to use e-cigarettes, vapor hookah, and smokeless tobacco. The researchers recommend an educational intervention using interactive online modules to address students' knowledge deficits about health risks.
The Impact of Trying Electronic Cigarettes on CigaretteSmoki.docxrtodd33
The Impact of Trying Electronic Cigarettes on Cigarette
Smoking by College Students: A Prospective Analysis
Erin L. Sutfin, PhD, Beth A. Reboussin, PhD, Beata Debinski, MHS, Kimberly G. Wagoner, DrPH, MPH, John Spangler, MD, MPH, and Mark Wolfson, PhD
There has been considerable growth in the
availability, marketing, sales, and use of elec-
tronic nicotine delivery systems, often referred
to as “e-cigarettes,” over the past several years.
Product sales in the United States have doubled
every year since 2008, and securities analysts
estimate the e-cigarette market is now approx-
imately a $2.5 billion industry.1 E-cigarette use
has rapidly increased among adolescents and
adults. From 2011 to 2012, rates of ever using
e-cigarettes among US middle and high school
students doubled from 3.3% to 6.8%.2 Similar
increases have been seen among US adults.3,4
Recent data suggest that e-cigarette use is
highest among young adults. Data from the
2012---2013 National Adult Tobacco Survey
show that young adults aged18 to 24 years had
a higher prevalence of e-cigarette use (8.3%)
than did the adult population as a whole
(4.2%).5 Similarly, with data from dual frame
surveys of national probability samples of
adults, McMillen et al. found that current
e-cigarette use in 2013 by young adults aged18
to 24 years (14.2%) was higher than was that
among adults aged 25 to 44 years (8.6%), 45
to 65 years (5.5%), and older than 65 years
(1.2%).4
Available data on e-cigarette use by college
students are limited, with most coming from
single-state or individual campus studies.6---9
College students are an important group to
study for several reasons. First, young adult-
hood is a period of many life transitions and
accompanying stress.10 The tobacco industry is
well aware of this vulnerable period and
recognizes it as a promising period for tobacco
use initiation and transition to addiction.11
Thus, college students are a target market for
the tobacco industry.11,12 College students are
often early adopters of novel products and
have historically been at the forefront of
societal changes in substance use that later
materialize in the general population.13 In
a cross-sectional study of college students in
North Carolina in 2009, Sutfin et al.6 found
that college students’ lifetime prevalence of
e-cigarette use was 4.9%, which was higher
than were rates of use among other adults at
the time,14,15 suggesting that college students
were early adopters of e-cigarettes.6
Additionally, there was an association be-
tween e-cigarette use and sensation seeking in
bivariate, but not multivariable, models. How-
ever, membership in Greek letter organizations
was associated with e-cigarette use in multi-
variable models. These data suggest that col-
lege students may be drawn to e-cigarettes
owing, at least in part, to their novelty. Finally,
college students are an important group to
study because they have a unique pattern of
cigarette smoking that is often marked by so.
A study of 1,300 college students found that of the 43 students whose initial nicotine exposure was from e-cigarettes, only 1 went on to smoke regular tobacco cigarettes. This contradicts claims that e-cigarettes act as a gateway to smoking. While some public health groups worry e-cigarettes could increase youth nicotine addiction, this study found that the vast majority of students who started with e-cigarettes were not currently using nicotine or tobacco products. The issue of whether e-cigarettes truly lead youth to smoking, and increased nicotine addiction, or if they can benefit public health requires more research.
This qualitative study explored college students' knowledge, attitudes, and experiences regarding nicotine-tobacco products like e-cigarettes and hookah. Three focus groups discussed: their sources of information about these products; situations and social contexts of use; differences between products; and views on health effects. Themes that emerged included use of e-cigarettes and hookah for social purposes rather than addiction, a lack of accessible information, and beliefs that these products are safer alternatives to cigarettes. The researchers recommend an educational intervention using interactive online modules to address knowledge gaps, present research-based information, and help students relate lessons to their social environments.
Society for research on nicotine and tobacco conference abstracts srnt 2014Georgi Daskalov
This document summarizes six research studies presented at the 2014 Society for Research on Nicotine and Tobacco conference. Three key findings are:
1) A study found that cytisine, a plant-derived alkaloid, was as effective as nicotine replacement therapy for smoking cessation and had fewer side effects.
2) A randomized controlled trial found that sending smokers placebo nicotine patches by mail, which induced more quit attempts, led to higher long-term smoking abstinence rates than asking smokers to obtain active patches themselves.
3) Qualitative research identified factors that prevented youth and young adult smokers and non-smokers from initiating e-cigarettes, such as health concerns, cost, and social dis
Article Review Grading Rubric
Grade Calculation: (Summary * 0.30) + (Critique * 0.5) + (Grammar/Style * 0.2) = Final Grade
Criteria Excellent
(100 points)
Very Good
(93 points)
Satisfactory
(86 points)
Needs Improvement
(79 point)
Unacceptable
(0 points)
Score
Summary:
Summarizes the
context and
content of the
selected article
Provides a very
thorough and
clear and concise
summary of the
article context and
content.
Provides a clear
and concise
summary of the
article context and
content.
Provides a clear
but shallow
summary of the
article; may be
excessively brief or
may include some
extraneous
information.
Provides a
somewhat muddled,
unclear and
rambling summary
of the article.
Provides an
unclear and
unintelligible
summary of the
article OR No
summary at all.
Critique:
Identifies and
describes your
personal reaction
to the article
Thoroughly
describes your
personal reaction
to the article;
includes
discussion of the
relevant issues
within the article.
Describes your
personal reaction
to the article;
includes a
simplistic
discussion of the
relevant issues
within the article.
Describes your
personal reaction to
the article; includes
no discussion of
the relevant issues
within the article.
Attempts to
describe your
personal reaction to
the article, but lacks
a logical flow and
reaction is muddled;
no discussion of
any relevant issues
in the article.
Provides an
unclear,
unintelligible and
illogical
description of
personal reaction
OR No description
of personal
reaction at all.
Grammar/Style:
Grammar,
mechanics, and
APA style for
references and
citations
Contains all
correct
information
regarding article
title, author name,
and article source
and date.
Consistently
contains accurate
and proper
grammatical
conventions,
spelling, and
punctuation.
Clearly and
consistently uses
proper APA
formatting for
references
/citations.
Contains all
correct info
regarding article
title, author name,
and article source
and date.
Contains accurate
and proper
grammatical
conventions,
spelling, and
punctuation most
of the time; errors
do not interfere
with paper’s
meaning.
Consistently uses
APA for citations/
references
Contains mostly
correct info
regarding article
title, author name,
and article source
and date. Contains
frequent errors in
grammatical
conventions,
spelling, and
punctuation; errors
begin to interfere
with paper’s
meaning.
Inconsistently uses
APA formatting for
citations/references
Contains incorrect
info regarding
article title, author
name, and article
source and date.
Contains numerous
errors in
grammatical
conventions,
spelling, and
punctuation;
substantially
interferes with
paper’s meaning.
Consistently fails to
use APA for
references/citations.
Response is
totally
unintelli.
The document describes an article review grading rubric. It provides criteria for evaluating student reviews of articles in four areas: summary, critique, grammar/style, and an overall score. Summary is worth 30% of the grade and evaluates how thoroughly the student summarized the article context and content. Critique is worth 50% and examines the student's personal reaction to and discussion of issues in the article. Grammar/style is worth 20% and reviews proper grammar, mechanics, and APA style. Scores range from excellent to unacceptable in each area to calculate the final grade.
This document summarizes research on young adults who ordered nicotine patches or gum through an online ordering system established by Leave The Pack Behind. Over 1,100 young adult smokers across Ontario ordered products in the first 105 days. Users were a diverse group of both light and heavy smokers. While 44% smoked less than 10 cigarettes per day, 86% smoked their first cigarette within an hour of waking, indicating high nicotine dependence. Heavy smokers were more likely to order patches while light smokers ordered patches and gum equally. The results demonstrate young adults are interested in and willing to seek nicotine replacement therapies.
This study aims to assess the feasibility and effectiveness of using e-cigarettes for smoking reduction and harm reduction compared to placebo e-cigarettes. It will recruit 80 daily smoker participants aged 21-35 and randomly assign them to use e-cigarettes containing 4.5% nicotine or 0% nicotine placebo e-cigarettes for 3 weeks. The study will collect data through surveys and 4 times daily text messages to assess patterns of cigarette and e-cigarette use, nicotine cravings, and satisfaction. It hypothesizes that nicotine e-cigarette use will reduce cigarette consumption more than placebo e-cigarettes over the course of the study.
Effectiveness of clinical pharmacist intervention on smoking secessionpharmaindexing
The document summarizes a study on the effectiveness of a clinical pharmacist-led smoking cessation intervention program. The study analyzed baseline characteristics of 80 smokers divided into a test and control group. It found that over half of participants in both groups were over 65 years old, all were male, and most worked in business or farming. The pharmacist program helped over half of participants quit smoking at 1 and 3 months, with higher attendance rates linked to higher quit rates. However, steps could be taken to maximize the pharmacist's time while still achieving good patient outcomes. The most common reasons for quitting were health concerns.
Parrish Medical Center | survey finds support for banning e cigarettes for kidsParrish_Medical_Center
One of America's Finest Healing Environments Located in Titusville Florida specializing in Cardiology, Neurology, Joint & Spine, Obstetrics Cancer treatment-Our approach to health and wellness blends the science of evidence based medicine with the art of healing experiences.
Tobacco smoking is a major public health threat for both
smokers and nonsmokers. There is accumulating evidence
demonstrating that smoking causes several human
diseases, including those affecting the cardiovascular system.
Indeed, tobacco smoking is responsible for up to 30% of heart
disease–related deaths in the United States each year.1 This
is the single most preventable risk factor related to the
development of cardiovascular disease, bringing about a trend
toward tobacco harm reduction that started years ago.2 As
tobacco usage declined over time in the United States,
industries introduced an alternative known as electronic
cigarettes (e-cigarettes) claiming they were a healthier
alternative to tobacco smoking.3
Since then, the number of e-cigarette users has increased
significantly because of the perception that they serve as a
healthy substitute to tobacco consumption with minimal or no
harm, a lack of usage regulations (although that has now
changed), and the appealing nature of these devices, among
other reasons.4 Consequently, e-cigarettes became the most
commonly used smoking products, especially among youth,
with more than a 9-fold increase in usage from 2011 to
2015.5 Based on these considerations, it is clear that there
are many unanswered questions regarding the overall safety,
efficacy of harm reduction, and the long-term health impact of
these devices.
Besides their potential negative health effects on users,
there is increasing evidence that e-cigarettes emit considerable
levels of toxicants, such as nicotine, volatile organic
compounds, and carbonyls, in addition to releasing particulate
matter (PM).6,7 Thus, they possess a potential harm to
nonusers either through secondhand or thirdhand exposure.
This is especially the case in vulnerable populations, such as
children, elderly, pregnant females, and those with a history of
This document describes a study assessing the knowledge, attitudes, and beliefs of university students at risk of becoming first-time electronic cigarette users. The study involved surveying 455 students, identifying 39 at-risk participants. Most students were aware of e-cigarettes and many had tried them or were contemplating using them. Based on pre-testing different communication designs with the at-risk group, three designs - a hand with text, aerosol spray can, and infographic - tested most favorably and will be implemented in a campus health communication campaign to educate students on e-cigarette risks. The project aims to contribute to the university's initiative to discourage first-time e-cigarette use among students.
perceptions of pregnant women to avoid smoking side effects revised final copyjustus kimondo
This document discusses perceptions of pregnant women regarding smoking and using electronic cigarettes. It begins with an introduction describing the harmful effects of smoking on both mother and developing baby. The purpose is then stated to discuss eight empirical studies on perceptions of pregnant mothers to avoid smoking side effects by quitting or using e-cigarettes as an alternative. Several studies are summarized that examine perceptions and beliefs of pregnant women and postpartum mothers. The studies generally found initial attraction to e-cigarettes to reduce harm, but many returned to traditional cigarettes. The document concludes nurses should educate pregnant women that e-cigarettes still pose risks and are not a safe alternative to smoking.
Smoking has negative effects on students' health, finances, and behavior according to a research paper. It discusses how smoking is harmful to students' health due to the 4000 chemicals in cigarettes. It also negatively impacts students financially as money spent on cigarettes would be better spent on other needs or saved. Additionally, smoking can lead to negative behaviors in students such as stress, aggression, and losing focus in class. The paper recommends preventing youth smoking through parental influence, education, and following Islamic rulings against the consumption of tobacco.
708There is a wealth of literature highlighting the ne.docxevonnehoggarth79783
708
T
here is a wealth of literature highlighting the
negative physical (eg, type II diabetes, car-
diovascular problems) and psychosocial (eg,
depression, low self-worth) consequences of ado-
lescent obesity.1-3 However, less attention has been
given to the role adolescent weight status plays in
future health-risk behaviors, such as problematic
substance use. With adolescent overweight and
obesity rates remaining high (33.6% overweight,
18.4% obese 12-19 years),4 and substance use
more prevalent in young adulthood than any other
developmental period,5 identification of adolescent
weight status as a predictor of future problematic
substance use behavior is likely to have a signifi-
cant impact on research and clinical work aimed to
reduce multiple health risks in the transition from
adolescence to adulthood.
Adolescence is a crucial period for prevention ef-
forts aimed to reduce problematic substance use in
young adulthood. According to the National Survey
of Drug Use and Health,5 young adults have the
highest rates of current tobacco use (39.5% overall
including 33.5% cigarette use) and illicit drug use
(21.4%), with 19.0% using marijuana in the past
month. Binge drinking has been reported for 39.8%
and heavy alcohol use for 12.1% of 18- to 25-year-
olds. In the past 30 years, many epidemiological
longitudinal studies have identified several key
risk factors for problematic substance use, includ-
ing regular cigarette smoking, binge drinking, and
marijuana use, in adolescence and young adult-
hood. Temperament,6 behavioral disinhibition,7 ex-
ternalizing behaviors,8 poor parental monitoring,9
lack of parental support,10 negative peer interac-
tions,11 and affiliation with deviant peers12 have
been well-established as critical factors involved in
the development of problematic substance use.13-15
Considering the array of risk factors in adolescence
contributing to future problematic substance use,
it is likely that other health-risk conditions, such
as overweight or obesity status, are linked to prob-
lematic substance use behavior.
Little is currently known about the relationship
between adolescent weight status and future prob-
lematic substance use; however, use of an adoles-
cent developmental framework is likely to increase
our understanding of why this relationship may be
a significant one to address. One explanation may
be that a shared underlying factor like impulsivity
may explain co-occurring obesity and problematic
substance use. As children learn to self-regulate
behaviors, those who have difficulties with self-
control are more likely to over-consume energy-
dense food contributing to obesity risk16,17 and en-
gage in antisocial behaviors leading to substance
abuse and dependence.18,19 Although a shared
underlying factor explanation is plausible, under-
standing adolescent behavior without considering
the social context is incomplete.
H. Isabella Lanza, Research Associate and Chri.
This document discusses barriers and facilitators to e-cigarettes reducing smoking rates in the UK, particularly among deprived groups. It finds that while e-cigarettes could help reduce smoking if promoted properly, concerns over their safety and lack of research on their use among deprived populations currently prevent this. It calls for better communication of e-cigarettes' relative safety compared to smoking, as well as more standardized research on e-cigarette usage patterns among different socioeconomic groups in the UK. This would help establish best practices for including e-cigarettes in smoking cessation programs and policies.
pregnant women perception to avoid side effects of smokingjustus kimondo
Eight empirical studies were summarized that examined perceptions of pregnant women regarding avoiding smoking side effects through quitting or using e-cigarettes. Most studies found that while pregnant women were initially attracted to e-cigarettes as a harm reduction method, they often relapsed back to traditional cigarettes. The studies highlighted a lack of knowledge about e-cigarette health risks and the importance of quitting smoking beyond the first trimester. Qualitative research identified justifications pregnant smokers used and an opportunity for nurses to address misconceptions. The overall findings suggest that pregnant women show interest in alternatives to smoking but have uncertainty around e-cigarette safety. Education from healthcare providers is needed to inform choices and support smoking cessation during and after pregnancy.
This study surveyed 797 people through Amazon Mechanical Turk to understand perceptions of e-cigarettes among smokers and non-smokers. The results showed that smokers (72%) were more likely than non-smokers (14%) to have tried e-cigarettes. Smokers perceived e-cigarettes as cheaper than cigarettes and more helpful for quitting smoking, while non-smokers held the opposite beliefs. The top reasons for smokers wanting to try e-cigarettes were for help quitting smoking, while non-smokers cited curiosity; concerns about safety and cost deterred smokers while non-smokers did not want to smoke. The findings suggest tailoring public health messages about e-cigarettes separately for smokers
E-cigarette Summit - The New Tobacco Wars - 7 December 2021Clive Bates
The presentation gives my take on the conflict raging in tobacco control. It looks at where things are going wrong in science, risk communication, policy, and youth politics. It then looks at causes: institutional and cultural inertia. And finally, finds hope in the basic processes of innovation.
More teens now use e-cigarettes than traditional tobacco cigarettes or any other tobacco product according to a national study. Specifically, 9% of 8th graders and 16% of 10th graders reported using e-cigarettes in the past 30 days compared to only 4% and 7% respectively reporting tobacco cigarette use. E-cigarette use has grown rapidly among teens in recent years and may serve as a gateway to nicotine addiction and reversal of long-term declines in youth smoking. However, many teens do not view e-cigarettes as harmful to health. Further research is still needed to fully understand the long-term health impacts of e-cigarette use.
More teens now use e-cigarettes than traditional tobacco cigarettes or any other tobacco product according to a national study. Specifically, 9% of 8th graders and 16% of 10th graders reported using e-cigarettes in the past 30 days compared to only 4% and 7% respectively reporting tobacco cigarette use. E-cigarette use has grown rapidly among teens in recent years and may serve as a gateway to nicotine addiction and reversal of long-term declines in youth smoking. However, many teens do not view e-cigarettes as harmful to health. Further research is still needed to fully understand the long-term health impacts of e-cigarette use.
Electronic Cigarettes: Evidenced Based Decision Making PresentationKaylaRobinson29
An assignment for Dental Hygiene Theory 1 was to create an annotated bibliography for a research topic of our choice. This project was designed to challenge our critical thinking and decision making skills. I chose to research electronic cigarettes and their effects on oral health. It was interesting to compare different literature on this subject and the validity that they held. Most of the articles were very similar in the information portrayed and were very educational.
This document discusses electronic cigarettes (ECs) and whether they are safer than combustible cigarettes. It summarizes that while ECs may expose users to fewer harmful chemicals than smoking, the long-term safety of ECs is still unknown. Studies have found potentially harmful chemicals in EC vapor, but in much lower amounts than in cigarette smoke. The regulation of ECs is also debated, as stricter rules may discourage innovation but make the products less appealing to youth and non-smokers. The evidence that ECs help smokers quit is also limited and inconclusive. More research is still needed to understand the public health impact of ECs.
Tobacco Harm Reduction by Somchai Bovornkitti* in Crimson Publishers: Telemedicine and e-Health open access journals
Cigarette smoke contain approximately 250 different chemicals known to be harmful to human health. Thousands of harmful chemical substances produce by the combustion of tobacco. The health impacts such as cancer and chronic lung disease are not only associated with smokers but also people who are exposed to secondhand smoke. Tobacco Harm Reduction is a concept to minimize the impacts of tobacco on the individual and on society at large. A key component of this strategy is using alternative source of nicotine as a substitute to tobacco cigarettes. Electronic cigarette and heated tobacco are alternatives that might have potential in reduce harm from smokes. This paper elaborates on available research associated with electronic cigarette and heated tobacco with harm reduction and risk perspective.
https://crimsonpublishers.com/tteh/fulltext/TTEH.000522.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more Articles on Telemedicine and e-Health open access journals
please click on link: https://crimsonpublishers.com/tteh/index.php
Please follow the below link for our LinkedIn page
https://www.linkedin.com/company/crimsonpublishers
Effect of a smoking prevention program on smoking related knowledge, refusal ...Alexander Decker
This study evaluated the effects of a three-week smoking prevention program on 32 non-smoking adolescents aged 10-18 years old in the Philippines. The program consisted of eight interactive sessions based on health behavior theories. Participants completed questionnaires before and after measuring smoking knowledge, refusal self-efficacy, attitudes, and intentions. Results found that after the program, participants had higher smoking knowledge and refusal self-efficacy, less favorable attitudes toward smoking, and lower intentions to smoke in the future. The study suggests smoking prevention programs can positively impact important factors influencing adolescent smoking behavior.
Your company name
Your name
Instruction Page
1. On the cover page
a. Replace ‘Your Company Name’ with your company name, city and state
b. Replace ‘Date’ with the date of the plan
c. Consider inserting graphics:
i. Company logo
ii. Insert a picture or graphic of your product or service
iii. Photo of your facilities
iv. Photo of your location
2. Replace ‘ENTER YOUR COMPANY NAME HERE’ with your company name on the page with the Statement of Confidentiality & Non-Disclosure
3. Open the document header and enter your company name and your name
4. Update the table of contents as you build your business plan.
Delete this page before submitting your business plan.
Business Plan
Your Company Name Here
City, State
Date
Statement of Confidentiality & Non-Disclosure
THIS BUSINESS PLAN CONTAINS PROPRIETARY AND CONFIDENTIAL INFORMATION.
All data submitted to the receiver is provided in reliance upon its consent not to use or disclose any information contained herein except in the context of its business dealings with ENTER YOUR COMPANY NAME HERE (Company). The recipient of this document agrees to inform its present and future employees and partners who view or have access to the document's content of its confidential nature.
The recipient agrees to instruct each employee that they must not disclose any information concerning this document to others except to the extent such matters are generally known to, and are available for use by, the public. The recipient also agrees not duplicate or distribute or permit others to duplicate or distribute any material contained herein without the Company's express written consent.
The Company retains all title, ownership and intellectual property rights to the material and trademarks contained herein, including all supporting documentation, files, marketing material, and multimedia.
Disclaimer Notice
THIS BUSINESS PLAN IS FOR INFORMATIONAL PURPOSES ONLY AND DOES NOT CONSTITUTE AN OFFER TO SELL OR THE SOLICITATION OF AN OFFER TO BUY ANY SECURITIES.
The Company reserves the right, in its sole discretion, to reject any and all proposals made by or on behalf of any recipient, to accept any such proposals, to negotiate with one or more recipients at any time, and to enter into a definitive agreement without prior notice to other recipients. The company also reserves the right to terminate, at any time, further participation in the investigation and proposal process by, or discussions or negotiations with, any recipient without reason.
BY ACCEPTANCE OF THIS DOCUMENT, THE RECIPIENT AGREES TO BE BOUND BY THE AFOREMENTIONED STATEMENT.
Table of Contents
Introduction and Overview 6
Executive Summary 6
Objectives 6
Mission 6
Keys to Success 6
Company Summary 6
Company Ownership 6
Start-up 6
What We Sell 7
Summary 7
Our products 7
Our services 7
Market Analysis and Sales Forecast 8
Market and Sales Forecast Summary 8
Total Market 8
Target Market Summar.
Your Company NameYour Company NameBudget Proposalfor[ent.docxhyacinthshackley2629
Your Company Name
Your Company Name
Budget Proposal
for
[enter years here]
BUSN278
[Term]
Professor[name]
DeVry University
Table of Contents
Section
Title
Subsection
Title
Page Number1.0Executive Summary
2.0Sales Forecast
2.1Sales Forecast
2.2Methods and Assumptions
3.0Capital Expenditure Budget
4.0Investment Analysis
4.1Cash Flows
4.2NPV Analysis
4.3Rate of Return Calculations
4.4Payback Period Calculations
5.0Pro Forma Financial Statements
5.1Pro Forma Income Statement
5.2Pro Forma Balance Sheet
5.3Pro Forma Cash Budget
6.0Works Cited
7.0Appendices
7.1Appendix 1: [description]
7.2Appendix 2:
[description]
(Please put page numbers in the last column of the table of contents above, because they apply to your finished assignment. Do this after your project is complete. Remove this text and all text that is in italics in this template when finished with your project.)
(Also, please submit your Excel spreadsheet that shows your supporting calculations.)
1.0 Executive Summary
The first paragraph of this executive summary should give a brief description of the business to which this budget applies. Very briefly describe the products and services of this company, the geography or demographics of the customers it serves, and why people purchase the main product of this business. Much or all of this information will be found in the business profile provided to you. Please use your own words, and please do not simply copy and paste the explanation in the course materials. Make assumptions if necessary.
Also, provide a second paragraph that describes how the budget supports the company’s strategy.
Finally, provide a third paragraph in which you summarize the key points from your budget, including the planning horizon; the amount of up-front investment; the NPV, payback, and IRR of the project; and key figures from your income statement, cash budget, and balance sheet.
Remember, this is not a thesis or introduction of what you will talk about—it contains the major, specific content of each section. The second and third paragraphs should be written after you have completed all other sections of this template.
As you complete sections of this template, please remove all italicized text in all sections of this template and replace it with your own text or you will lose points!
2.0 Sales Forecast
Briefly introduce the sales forecast section.
2.1 Sales Forecast
Here you should include a simple table showing the years and the total sales for each year, along with a brief explanation of why sales are expected to rise, fall, change, or stay the same in certain years. Provide a brief explanation of the sales forecast, indicating why you expect sales to rise or fall during the planning horizon. Your explanation should be consistent with the trends and changes in sales found in your table.
Year 1
Year 2
Year 3
Year 4
Year 5
Sales
2.2 Methods and Assumptions
Here you should describe how you arrived at your sales forecast in sect.
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The document describes an article review grading rubric. It provides criteria for evaluating student reviews of articles in four areas: summary, critique, grammar/style, and an overall score. Summary is worth 30% of the grade and evaluates how thoroughly the student summarized the article context and content. Critique is worth 50% and examines the student's personal reaction to and discussion of issues in the article. Grammar/style is worth 20% and reviews proper grammar, mechanics, and APA style. Scores range from excellent to unacceptable in each area to calculate the final grade.
This document summarizes research on young adults who ordered nicotine patches or gum through an online ordering system established by Leave The Pack Behind. Over 1,100 young adult smokers across Ontario ordered products in the first 105 days. Users were a diverse group of both light and heavy smokers. While 44% smoked less than 10 cigarettes per day, 86% smoked their first cigarette within an hour of waking, indicating high nicotine dependence. Heavy smokers were more likely to order patches while light smokers ordered patches and gum equally. The results demonstrate young adults are interested in and willing to seek nicotine replacement therapies.
This study aims to assess the feasibility and effectiveness of using e-cigarettes for smoking reduction and harm reduction compared to placebo e-cigarettes. It will recruit 80 daily smoker participants aged 21-35 and randomly assign them to use e-cigarettes containing 4.5% nicotine or 0% nicotine placebo e-cigarettes for 3 weeks. The study will collect data through surveys and 4 times daily text messages to assess patterns of cigarette and e-cigarette use, nicotine cravings, and satisfaction. It hypothesizes that nicotine e-cigarette use will reduce cigarette consumption more than placebo e-cigarettes over the course of the study.
Effectiveness of clinical pharmacist intervention on smoking secessionpharmaindexing
The document summarizes a study on the effectiveness of a clinical pharmacist-led smoking cessation intervention program. The study analyzed baseline characteristics of 80 smokers divided into a test and control group. It found that over half of participants in both groups were over 65 years old, all were male, and most worked in business or farming. The pharmacist program helped over half of participants quit smoking at 1 and 3 months, with higher attendance rates linked to higher quit rates. However, steps could be taken to maximize the pharmacist's time while still achieving good patient outcomes. The most common reasons for quitting were health concerns.
Parrish Medical Center | survey finds support for banning e cigarettes for kidsParrish_Medical_Center
One of America's Finest Healing Environments Located in Titusville Florida specializing in Cardiology, Neurology, Joint & Spine, Obstetrics Cancer treatment-Our approach to health and wellness blends the science of evidence based medicine with the art of healing experiences.
Tobacco smoking is a major public health threat for both
smokers and nonsmokers. There is accumulating evidence
demonstrating that smoking causes several human
diseases, including those affecting the cardiovascular system.
Indeed, tobacco smoking is responsible for up to 30% of heart
disease–related deaths in the United States each year.1 This
is the single most preventable risk factor related to the
development of cardiovascular disease, bringing about a trend
toward tobacco harm reduction that started years ago.2 As
tobacco usage declined over time in the United States,
industries introduced an alternative known as electronic
cigarettes (e-cigarettes) claiming they were a healthier
alternative to tobacco smoking.3
Since then, the number of e-cigarette users has increased
significantly because of the perception that they serve as a
healthy substitute to tobacco consumption with minimal or no
harm, a lack of usage regulations (although that has now
changed), and the appealing nature of these devices, among
other reasons.4 Consequently, e-cigarettes became the most
commonly used smoking products, especially among youth,
with more than a 9-fold increase in usage from 2011 to
2015.5 Based on these considerations, it is clear that there
are many unanswered questions regarding the overall safety,
efficacy of harm reduction, and the long-term health impact of
these devices.
Besides their potential negative health effects on users,
there is increasing evidence that e-cigarettes emit considerable
levels of toxicants, such as nicotine, volatile organic
compounds, and carbonyls, in addition to releasing particulate
matter (PM).6,7 Thus, they possess a potential harm to
nonusers either through secondhand or thirdhand exposure.
This is especially the case in vulnerable populations, such as
children, elderly, pregnant females, and those with a history of
This document describes a study assessing the knowledge, attitudes, and beliefs of university students at risk of becoming first-time electronic cigarette users. The study involved surveying 455 students, identifying 39 at-risk participants. Most students were aware of e-cigarettes and many had tried them or were contemplating using them. Based on pre-testing different communication designs with the at-risk group, three designs - a hand with text, aerosol spray can, and infographic - tested most favorably and will be implemented in a campus health communication campaign to educate students on e-cigarette risks. The project aims to contribute to the university's initiative to discourage first-time e-cigarette use among students.
perceptions of pregnant women to avoid smoking side effects revised final copyjustus kimondo
This document discusses perceptions of pregnant women regarding smoking and using electronic cigarettes. It begins with an introduction describing the harmful effects of smoking on both mother and developing baby. The purpose is then stated to discuss eight empirical studies on perceptions of pregnant mothers to avoid smoking side effects by quitting or using e-cigarettes as an alternative. Several studies are summarized that examine perceptions and beliefs of pregnant women and postpartum mothers. The studies generally found initial attraction to e-cigarettes to reduce harm, but many returned to traditional cigarettes. The document concludes nurses should educate pregnant women that e-cigarettes still pose risks and are not a safe alternative to smoking.
Smoking has negative effects on students' health, finances, and behavior according to a research paper. It discusses how smoking is harmful to students' health due to the 4000 chemicals in cigarettes. It also negatively impacts students financially as money spent on cigarettes would be better spent on other needs or saved. Additionally, smoking can lead to negative behaviors in students such as stress, aggression, and losing focus in class. The paper recommends preventing youth smoking through parental influence, education, and following Islamic rulings against the consumption of tobacco.
708There is a wealth of literature highlighting the ne.docxevonnehoggarth79783
708
T
here is a wealth of literature highlighting the
negative physical (eg, type II diabetes, car-
diovascular problems) and psychosocial (eg,
depression, low self-worth) consequences of ado-
lescent obesity.1-3 However, less attention has been
given to the role adolescent weight status plays in
future health-risk behaviors, such as problematic
substance use. With adolescent overweight and
obesity rates remaining high (33.6% overweight,
18.4% obese 12-19 years),4 and substance use
more prevalent in young adulthood than any other
developmental period,5 identification of adolescent
weight status as a predictor of future problematic
substance use behavior is likely to have a signifi-
cant impact on research and clinical work aimed to
reduce multiple health risks in the transition from
adolescence to adulthood.
Adolescence is a crucial period for prevention ef-
forts aimed to reduce problematic substance use in
young adulthood. According to the National Survey
of Drug Use and Health,5 young adults have the
highest rates of current tobacco use (39.5% overall
including 33.5% cigarette use) and illicit drug use
(21.4%), with 19.0% using marijuana in the past
month. Binge drinking has been reported for 39.8%
and heavy alcohol use for 12.1% of 18- to 25-year-
olds. In the past 30 years, many epidemiological
longitudinal studies have identified several key
risk factors for problematic substance use, includ-
ing regular cigarette smoking, binge drinking, and
marijuana use, in adolescence and young adult-
hood. Temperament,6 behavioral disinhibition,7 ex-
ternalizing behaviors,8 poor parental monitoring,9
lack of parental support,10 negative peer interac-
tions,11 and affiliation with deviant peers12 have
been well-established as critical factors involved in
the development of problematic substance use.13-15
Considering the array of risk factors in adolescence
contributing to future problematic substance use,
it is likely that other health-risk conditions, such
as overweight or obesity status, are linked to prob-
lematic substance use behavior.
Little is currently known about the relationship
between adolescent weight status and future prob-
lematic substance use; however, use of an adoles-
cent developmental framework is likely to increase
our understanding of why this relationship may be
a significant one to address. One explanation may
be that a shared underlying factor like impulsivity
may explain co-occurring obesity and problematic
substance use. As children learn to self-regulate
behaviors, those who have difficulties with self-
control are more likely to over-consume energy-
dense food contributing to obesity risk16,17 and en-
gage in antisocial behaviors leading to substance
abuse and dependence.18,19 Although a shared
underlying factor explanation is plausible, under-
standing adolescent behavior without considering
the social context is incomplete.
H. Isabella Lanza, Research Associate and Chri.
This document discusses barriers and facilitators to e-cigarettes reducing smoking rates in the UK, particularly among deprived groups. It finds that while e-cigarettes could help reduce smoking if promoted properly, concerns over their safety and lack of research on their use among deprived populations currently prevent this. It calls for better communication of e-cigarettes' relative safety compared to smoking, as well as more standardized research on e-cigarette usage patterns among different socioeconomic groups in the UK. This would help establish best practices for including e-cigarettes in smoking cessation programs and policies.
pregnant women perception to avoid side effects of smokingjustus kimondo
Eight empirical studies were summarized that examined perceptions of pregnant women regarding avoiding smoking side effects through quitting or using e-cigarettes. Most studies found that while pregnant women were initially attracted to e-cigarettes as a harm reduction method, they often relapsed back to traditional cigarettes. The studies highlighted a lack of knowledge about e-cigarette health risks and the importance of quitting smoking beyond the first trimester. Qualitative research identified justifications pregnant smokers used and an opportunity for nurses to address misconceptions. The overall findings suggest that pregnant women show interest in alternatives to smoking but have uncertainty around e-cigarette safety. Education from healthcare providers is needed to inform choices and support smoking cessation during and after pregnancy.
This study surveyed 797 people through Amazon Mechanical Turk to understand perceptions of e-cigarettes among smokers and non-smokers. The results showed that smokers (72%) were more likely than non-smokers (14%) to have tried e-cigarettes. Smokers perceived e-cigarettes as cheaper than cigarettes and more helpful for quitting smoking, while non-smokers held the opposite beliefs. The top reasons for smokers wanting to try e-cigarettes were for help quitting smoking, while non-smokers cited curiosity; concerns about safety and cost deterred smokers while non-smokers did not want to smoke. The findings suggest tailoring public health messages about e-cigarettes separately for smokers
E-cigarette Summit - The New Tobacco Wars - 7 December 2021Clive Bates
The presentation gives my take on the conflict raging in tobacco control. It looks at where things are going wrong in science, risk communication, policy, and youth politics. It then looks at causes: institutional and cultural inertia. And finally, finds hope in the basic processes of innovation.
More teens now use e-cigarettes than traditional tobacco cigarettes or any other tobacco product according to a national study. Specifically, 9% of 8th graders and 16% of 10th graders reported using e-cigarettes in the past 30 days compared to only 4% and 7% respectively reporting tobacco cigarette use. E-cigarette use has grown rapidly among teens in recent years and may serve as a gateway to nicotine addiction and reversal of long-term declines in youth smoking. However, many teens do not view e-cigarettes as harmful to health. Further research is still needed to fully understand the long-term health impacts of e-cigarette use.
More teens now use e-cigarettes than traditional tobacco cigarettes or any other tobacco product according to a national study. Specifically, 9% of 8th graders and 16% of 10th graders reported using e-cigarettes in the past 30 days compared to only 4% and 7% respectively reporting tobacco cigarette use. E-cigarette use has grown rapidly among teens in recent years and may serve as a gateway to nicotine addiction and reversal of long-term declines in youth smoking. However, many teens do not view e-cigarettes as harmful to health. Further research is still needed to fully understand the long-term health impacts of e-cigarette use.
Electronic Cigarettes: Evidenced Based Decision Making PresentationKaylaRobinson29
An assignment for Dental Hygiene Theory 1 was to create an annotated bibliography for a research topic of our choice. This project was designed to challenge our critical thinking and decision making skills. I chose to research electronic cigarettes and their effects on oral health. It was interesting to compare different literature on this subject and the validity that they held. Most of the articles were very similar in the information portrayed and were very educational.
This document discusses electronic cigarettes (ECs) and whether they are safer than combustible cigarettes. It summarizes that while ECs may expose users to fewer harmful chemicals than smoking, the long-term safety of ECs is still unknown. Studies have found potentially harmful chemicals in EC vapor, but in much lower amounts than in cigarette smoke. The regulation of ECs is also debated, as stricter rules may discourage innovation but make the products less appealing to youth and non-smokers. The evidence that ECs help smokers quit is also limited and inconclusive. More research is still needed to understand the public health impact of ECs.
Tobacco Harm Reduction by Somchai Bovornkitti* in Crimson Publishers: Telemedicine and e-Health open access journals
Cigarette smoke contain approximately 250 different chemicals known to be harmful to human health. Thousands of harmful chemical substances produce by the combustion of tobacco. The health impacts such as cancer and chronic lung disease are not only associated with smokers but also people who are exposed to secondhand smoke. Tobacco Harm Reduction is a concept to minimize the impacts of tobacco on the individual and on society at large. A key component of this strategy is using alternative source of nicotine as a substitute to tobacco cigarettes. Electronic cigarette and heated tobacco are alternatives that might have potential in reduce harm from smokes. This paper elaborates on available research associated with electronic cigarette and heated tobacco with harm reduction and risk perspective.
https://crimsonpublishers.com/tteh/fulltext/TTEH.000522.php
For more Open access journals in Crimson Publishers
Please click on: https://crimsonpublishers.com/
For more Articles on Telemedicine and e-Health open access journals
please click on link: https://crimsonpublishers.com/tteh/index.php
Please follow the below link for our LinkedIn page
https://www.linkedin.com/company/crimsonpublishers
Effect of a smoking prevention program on smoking related knowledge, refusal ...Alexander Decker
This study evaluated the effects of a three-week smoking prevention program on 32 non-smoking adolescents aged 10-18 years old in the Philippines. The program consisted of eight interactive sessions based on health behavior theories. Participants completed questionnaires before and after measuring smoking knowledge, refusal self-efficacy, attitudes, and intentions. Results found that after the program, participants had higher smoking knowledge and refusal self-efficacy, less favorable attitudes toward smoking, and lower intentions to smoke in the future. The study suggests smoking prevention programs can positively impact important factors influencing adolescent smoking behavior.
Similar to 108Electronic cigarettes, or e-cigarettes,” are de-vi.docx (20)
Your company name
Your name
Instruction Page
1. On the cover page
a. Replace ‘Your Company Name’ with your company name, city and state
b. Replace ‘Date’ with the date of the plan
c. Consider inserting graphics:
i. Company logo
ii. Insert a picture or graphic of your product or service
iii. Photo of your facilities
iv. Photo of your location
2. Replace ‘ENTER YOUR COMPANY NAME HERE’ with your company name on the page with the Statement of Confidentiality & Non-Disclosure
3. Open the document header and enter your company name and your name
4. Update the table of contents as you build your business plan.
Delete this page before submitting your business plan.
Business Plan
Your Company Name Here
City, State
Date
Statement of Confidentiality & Non-Disclosure
THIS BUSINESS PLAN CONTAINS PROPRIETARY AND CONFIDENTIAL INFORMATION.
All data submitted to the receiver is provided in reliance upon its consent not to use or disclose any information contained herein except in the context of its business dealings with ENTER YOUR COMPANY NAME HERE (Company). The recipient of this document agrees to inform its present and future employees and partners who view or have access to the document's content of its confidential nature.
The recipient agrees to instruct each employee that they must not disclose any information concerning this document to others except to the extent such matters are generally known to, and are available for use by, the public. The recipient also agrees not duplicate or distribute or permit others to duplicate or distribute any material contained herein without the Company's express written consent.
The Company retains all title, ownership and intellectual property rights to the material and trademarks contained herein, including all supporting documentation, files, marketing material, and multimedia.
Disclaimer Notice
THIS BUSINESS PLAN IS FOR INFORMATIONAL PURPOSES ONLY AND DOES NOT CONSTITUTE AN OFFER TO SELL OR THE SOLICITATION OF AN OFFER TO BUY ANY SECURITIES.
The Company reserves the right, in its sole discretion, to reject any and all proposals made by or on behalf of any recipient, to accept any such proposals, to negotiate with one or more recipients at any time, and to enter into a definitive agreement without prior notice to other recipients. The company also reserves the right to terminate, at any time, further participation in the investigation and proposal process by, or discussions or negotiations with, any recipient without reason.
BY ACCEPTANCE OF THIS DOCUMENT, THE RECIPIENT AGREES TO BE BOUND BY THE AFOREMENTIONED STATEMENT.
Table of Contents
Introduction and Overview 6
Executive Summary 6
Objectives 6
Mission 6
Keys to Success 6
Company Summary 6
Company Ownership 6
Start-up 6
What We Sell 7
Summary 7
Our products 7
Our services 7
Market Analysis and Sales Forecast 8
Market and Sales Forecast Summary 8
Total Market 8
Target Market Summar.
Your Company NameYour Company NameBudget Proposalfor[ent.docxhyacinthshackley2629
Your Company Name
Your Company Name
Budget Proposal
for
[enter years here]
BUSN278
[Term]
Professor[name]
DeVry University
Table of Contents
Section
Title
Subsection
Title
Page Number1.0Executive Summary
2.0Sales Forecast
2.1Sales Forecast
2.2Methods and Assumptions
3.0Capital Expenditure Budget
4.0Investment Analysis
4.1Cash Flows
4.2NPV Analysis
4.3Rate of Return Calculations
4.4Payback Period Calculations
5.0Pro Forma Financial Statements
5.1Pro Forma Income Statement
5.2Pro Forma Balance Sheet
5.3Pro Forma Cash Budget
6.0Works Cited
7.0Appendices
7.1Appendix 1: [description]
7.2Appendix 2:
[description]
(Please put page numbers in the last column of the table of contents above, because they apply to your finished assignment. Do this after your project is complete. Remove this text and all text that is in italics in this template when finished with your project.)
(Also, please submit your Excel spreadsheet that shows your supporting calculations.)
1.0 Executive Summary
The first paragraph of this executive summary should give a brief description of the business to which this budget applies. Very briefly describe the products and services of this company, the geography or demographics of the customers it serves, and why people purchase the main product of this business. Much or all of this information will be found in the business profile provided to you. Please use your own words, and please do not simply copy and paste the explanation in the course materials. Make assumptions if necessary.
Also, provide a second paragraph that describes how the budget supports the company’s strategy.
Finally, provide a third paragraph in which you summarize the key points from your budget, including the planning horizon; the amount of up-front investment; the NPV, payback, and IRR of the project; and key figures from your income statement, cash budget, and balance sheet.
Remember, this is not a thesis or introduction of what you will talk about—it contains the major, specific content of each section. The second and third paragraphs should be written after you have completed all other sections of this template.
As you complete sections of this template, please remove all italicized text in all sections of this template and replace it with your own text or you will lose points!
2.0 Sales Forecast
Briefly introduce the sales forecast section.
2.1 Sales Forecast
Here you should include a simple table showing the years and the total sales for each year, along with a brief explanation of why sales are expected to rise, fall, change, or stay the same in certain years. Provide a brief explanation of the sales forecast, indicating why you expect sales to rise or fall during the planning horizon. Your explanation should be consistent with the trends and changes in sales found in your table.
Year 1
Year 2
Year 3
Year 4
Year 5
Sales
2.2 Methods and Assumptions
Here you should describe how you arrived at your sales forecast in sect.
Your company recently reviewed the results of a penetration test.docxhyacinthshackley2629
Your company recently reviewed the results of a penetration test on your network. Several vulnerabilities were identified, and the IT security management team has recommended mitigation. The manager has asked you to construct a plan of action and milestones (POA&M) given that the following vulnerabilities and mitigations were identified:
The penetration test showed that not all systems had malware protection software in place. The mitigation was to write a malware defense process to include all employees and retest the system after the process was implemented.
The penetration test indicated that the data server that houses employee payroll records had an admin password of “admin.” The mitigation was to perform extensive hardening of the data server.
The penetration test also identified many laptop computers that employees brought to work and connected to the internal network,some of which were easily compromised. The mitigation was to write a bring your own device (BYOD) policy for all employees and train the employees how to use their devices at work.
Complete
the 1- to 2-page
Plan of Action and Milestones Template
. (Must use this template!)
.
Your company wants to explore moving much of their data and info.docxhyacinthshackley2629
Your company wants to explore moving much of their data and information technology infrastructure to the cloud. The company is a small online retailer and requires a database and a web storefront. Currently, only IT is over budget on database maintenance. The initial analysis points to significant cost savings by moving to a cloud environment.
Research
the differences between Infrastructure as a Service (IaaS), Software as a Service (SaaS), and Platform as a Service (PaaS).
Discuss
the differences between IaaS, SaaS, and PaaS. Give an example of the appropriate use of each of the cloud models (Iaas, SaaS, and PaaS).
.
Your company plans to establish MNE manufacturing operations in Sout.docxhyacinthshackley2629
Your company plans to establish MNE manufacturing operations in South Korea. You have been asked to conduct a cultural audit focusing on leadership behaviors of South Korea. The results of your report will be used for internal training for plant managers due to be reassigned to work with South Korean managers in a few months. You are aware of a high-collectivism culture with a Confucian code of ethical behavior in South Korea. What kinds of South Korean leadership behaviors would you expect to include in your report? Describe these in terms of interaction between the U.S. and Korean managers as well as interaction between Korean leader-followers.
By
Saturday, June 21, 2014
respond to the discussion question assigned by the faculty. Submit your response to the appropriate
Discussion Area
. Use the same
Discussion Area
to comment on your classmates' submissions and continue the discussion until
Wednesday, June 25, 2014
.
Comment on how your classmates would address differing views.
.
Your company just purchased a Dell server MD1420 DAS to use to store.docxhyacinthshackley2629
Your company just purchased a Dell server MD1420 DAS to use to store databases. the databases will contain all employee records and personal identified information (PII). You know that databases like this are often targets. The Chief Information Officer has asked you draft a diagram for the server and 3 connected workstations. The diagram must use proper UML icons.
- Research:
network topology to protect database server (Google Term and click images)
-
Create a diagram using proper UML
icon, the protects the server and the 3 workstations.
-
Include where Internet access will be located
, firewall and other details.
- The
body (Min 1 page)
- Provide a summary after the diagram how and why you topology should protect the database.
.
your company is moving to a new HRpayroll system that is sponsored .docxhyacinthshackley2629
your company is moving to a new HR/payroll system that is sponsored by a firm called Workday.com. You have been asked to oversee the stakeholder management aspects of this project. Identify some of the key stakeholders at your company and describe how you plan to keep them engaged during your year-long project. Be sure to include the appropriate methods since not all of your stakeholders are located at the HQ office in Herndon, VA.
.
Your company is considering the implementation of a technology s.docxhyacinthshackley2629
Your company is considering the implementation of a technology solution to address a business problem. As a member of the IT team for a manufacturing company, you were asked to select a product to address the identified needs, informing the stakeholders about its fit to the identified needs, and providing implementation details. Several past process changes have been unsuccessful at implementation and user acceptance. You will create two artifacts that communicate product information tailored to meet the needs of each of the following stakeholder groups:
• Audience 1: executive leadership of the organization, such as the CIO, CFO, etc.
• Audience 2: cross-functional team, including members from IT who will be implementing the product
.
Your company is a security service contractor that consults with bus.docxhyacinthshackley2629
Your company is a security service contractor that consults with businesses in the U.S. that require assistance in complying with HIPAA. You advertise a proven track record in providing information program security management, information security governance programs, risk management programs, and regulatory and compliance recommendations. You identify vulnerabilities, threats, and risks for clients with the end goal of securing and protecting applications and systems within their organization.
Your client is Health Coverage Associates, a health insurance exchange in California and a healthcare covered entity. The Patient Protection and Affordable Care Act (ACA) enables individuals and small businesses to purchase health insurance at federally subsidized rates. In the past 6 months, they have experienced:
A malware attack (i.e., SQL Injection) on a critical software application that processed and stored client protected health information (PHI) that allowed access to PHI stored within the database
An internal mistake by an employee that allowed PHI to be emailed to the wrong recipient who was not authorized to have access to the PHI
An unauthorized access to client accounts through cracking of weak passwords via the company’s website login
Health Coverage Associates would like you to
develop
a security management plan that would address the required safeguards to protect the confidentiality, integrity, and availability of sensitive data from the attacks listed above and protect their assets from the vulnerabilities that allowed the attacks to occur.
Write
a 1- to 2-page high-level executive summary of the legal and regulatory compliance requirements for Health Coverage Associates executives. The summary should provide
Accurate information on the HIPAA requirements for securing PHI
FISMA and HIPAA requirements for a security plan
Scope of the work you will perform to meet the Health Coverage Associates’ requests
Compile
a 1-to 2-page list of at least 10 of the CIS controls that provide key alignment with the administrative (policies), physical (secured facilities), and technical safeguards required under HIPAA to protect against the attacks listed above. Include corresponding NIST controls mapped to the selected CIS controls.
Write
a 1- to 2-page concise outline of the contents of the security management plan. Include
Policies Health Coverage Associates will need to manage, protect, and provide access to PHI
The recommended risk management framework Health Coverage Associates should adopt
Key elements Health Coverage Associates should include in its plan of actions and milestones
Cite
all sources using APA guidelines.
.
Your company has just sent you to a Project Management Conference on.docxhyacinthshackley2629
Your company has just sent you to a Project Management Conference on the latest trends in project scope management. When you return to work, you will have to provide a report at the staff meeting on what you learned.
In your initial post
, share some of the trends that you heard at the conference. Conduct research and use sources to support your findings. Be sure to acknowledge any sources you use.
.
Your company has designed an information system for a library. The .docxhyacinthshackley2629
Your company has designed an information system for a library. The project included a new network (wired and wireless), a data entry application, a Web site, database and documentation.
Design a generic test plan that describes the testing for an imaginary system, make sure to address unit, integration and system testing.
Create a one-page questionnaire to distribute to users in a post-implementation evaluation of a recent information system project. Include at least 10 questions that cover the important information you want to obtain.
.
Your company has had embedded HR generalists in business units for t.docxhyacinthshackley2629
Your company has had embedded HR generalists in business units for the past several years. Over that time, it has become more costly and more difficult to maintain standards, and is a frustration for business units to have that budget “hit.” The leadership has decided to move to a more centralized model of delivering HR services and has asked you to evaluate that proposition and begin establishing a project team to initiate the needed changes. The project team is selected, and you must now provide general direction.
.
Your company You are a new Supply Chain Analyst with the ACME.docxhyacinthshackley2629
Your company: You are a new Supply Chain Analyst with the ACME Corporation. We design specialty electronics that are components in larger finished goods such as major appliances, automobiles and industrial equipment. Manufacturing is outsourced to low-cost suppliers due to the significant labor contribution and closeness to electronic component suppliers.
Your product: ACME Corp. designs a leading-edge family of devices branded as “Voice Assistants.” These are add-on boxes that many OEMs are using as plug-and-play devices in a wide variety of Internet-of-Things products. They are also sold directly to consumers as after-market items, but only for IoT devices that were built with our proprietary data-port.
Figure 1: Product line of ACME Corp Voice Assistant IoT Add-on Boxes
Your task: Your Chief Supply Chain Officer (CSCO) is requesting a review of supplier-to-customer processes as related to recent growth in our company and increasing demand for faster responsiveness to customers. One alternative is to decentralize our inventory into regional Distribution Centers; however, our ERP system is currently limited in the data available to make some of these decisions – and the output reports are very antiquated. Starting off the process, the CSCO directed that your Analysis Team use population data to pro-rate our national sales data as a starting point. For this analysis, you are asked to focus only on the flagship product, Voice Assistant IoT Add-on Box, 4GB, SKU #123-456789. The challenge is now yours to complete some computations and interpret the results!
Your data: A detailed report from your ERP system along with secondary data from the U.S. Census Bureau (reference: https://www.census.gov/programs-surveys/popest/data/data-sets.html) is provided. (Note: Sales to Alaska, Hawaii and Puerto Rico are handled by a 3PL provider and therefore are NOT part of this analysis.) The consolidated EXCEL® file has incorporated several tasks already performed by the Analysis Team --- sort, cleanse, inventory optimization, etc. Other tasks remain for your team.
Detailed Requirements: Prepare a formal report summarizing your results and providing recommendations that are supported by facts. The required layout follows:
A. Supply Chain Management:
a. Identify a single key supplier and a single key customer for your product, including a brief description of their product.
b. Identify the proper type of business relationship that your company should have with the supplier and customer from Part A, above, then briefly describe the data that you would share with them.
c. When implementing Supply Chain Management with your #1 key supplier for the first time, create a timeline that lists each of the six SCOR processes in the order that you recommend implementation; include process leader (by job title), primary contact at supplier/customer (by job title), and duration to implement.
d. Briefly describe each of the four enablers of supply chain .
Your company has asked that you create a survey to collect data .docxhyacinthshackley2629
Your company has asked that you create a survey to collect data on customer satisfaction related to their health care experience at your hospital.
Assignment Details (4-5 pages)
Please Add Title to page
Page 1:
A brief summary of the health care issue/topic (wait time, medication errors, etc.)
Number and access of source to sample and population
Limitations of the survey (parameters)
Time line for completion of survey
Page 2: Survey Questions
Survey questions: Limit the questions to 10
Page 3: Compilation of Data
Time line for assessment and evaluation of data
Challenges faced during this process
Page 4: Results and Conclusions
Results of study
Conclusions and potential value of the findings
Reference page
Deliverable Length
4–5 pages
Title and reference pages
.
"Your Communications Plan"
Description
A.
What is your challenge or opportunity?
The topic I would like to present is pitching an Project idea for some investor to invest in my Women’s Resources center.(Voices Of Women)
B.
.
Why is this professionally important to you?
Goal
A.
What goal or outcome do you want to achieve with this communication?
I.
Is it clear, concise, and actionable?
Audience
A.
Who is you target audience?
What are the professional positions of the audience?
I.
What demographic characteristics will the audience comprise?
II.
What is your relationship to the audience?
III.
What background knowledge and expertise does the audience have?
IV.
What does the audience know, feel about, and expect concerning this communication?
V.
What preconceptions or biases do you possess that might prevent you from building rapport with your audience?
B.
What information is available about your audience?
A.
b.
c.
I.
What research/sources will you use to obtain information about the audience?
II.
What conclusions have you been able to draw about the audience?
C.
What tone will you
"Your Communications Plan"
Description
A.
What is your challenge or opportunity?
The topic I would like to present is pitching an Project idea for some investor to invest in my Women’s Resources center.(Voices Of Women)
B.
.
Why is this professionally important to you?
Goal
A.
What goal or outcome do you want to achieve with this communication?
I.
Is it clear, concise, and actionable?
Audience
A.
Who is you target audience?
What are the professional positions of the audience?
I.
What demographic characteristics will the audience comprise?
II.
What is your relationship to the audience?
III.
What background knowledge and expertise does the audience have?
IV.
What does the audience know, feel about, and expect concerning this communication?
V.
What preconceptions or biases do you possess that might prevent you from building rapport with your audience?
B.
What information is available about your audience?
A.
b.
c.
I.
What research/sources will you use to obtain information about the audience?
II.
What conclusions have you been able to draw about the audience?
C.
What tone will you use to convey your message?
I.
Is the setting casual or formal?
II.
Is the communication personal or impersonal?
Key Message
A.
What is the primary message you must convey to your audience?use to convey your message?
I.
Is the setting casual or formal?
II.
Is the communication personal or impersonal?
Key Message
A.
What is the primary message you must convey to your audience?
.
Your community includes people from diverse backgrounds. Answer .docxhyacinthshackley2629
Your community includes people from diverse backgrounds. Answer the following questions related to how culture affects nutrition.
1. How does your culture shape decisions that you make about nutrition? (Culture includes history, values, politics, economics, communication styles, beliefs, and practices.)
2. Describe at least 1 different cultures present at your community. How do these cultures impact food choices?
3. Describe how you interact with someone from another culture related to diet. Provide specific examples.
4. Assume that you are preparing a Thanks Giving dinner for a group of your classmates that represent a variety of cultures. Describe how you will prepare the menu and set the table. Include how you will address food safety at the picnic.
Explore ways to address the problem of food insecurity in your community.
1. What programs are available to meet the nutrition needs of individuals in the area?
2. What types of options exist in the area to purchase food?
3. What role do you believe society should take to ensure that individuals have access to adequate healthy food?
4. What do you see as your role in the community related to proper nutrition?
.
Your Communications Plan Please respond to the following.docxhyacinthshackley2629
"Your Communications Plan"
Please respond to the following:
Provide a brief overview of your Strategic Communications Plan. Include a short description for each of the following
in bullet point format
:
- The purpose of the communication
- Your goal
- Audience
- Key Message
- Supporting Points
- Channel Selection
- Action Request
Note:
Remember, feedback is a powerful and essential tool. Thoughtful, useful feedback is specific. It combines suggestions for improvement with the recognition of good ideas. When you offer feedback, you should contribute new ideas and new perspectives to help your peers learn and move forward.
.
Your Communication InvestigationFor your mission after reading y.docxhyacinthshackley2629
You are to observe human interaction for 15 minutes in a public setting, noting details of two people's conversation without interrupting. You should describe the communication environment and identify elements of the transactional communication model. Finally, post a brief report on the discussion board, and reply to two classmates' posts with empathetic perspectives on their observations.
Your Communications PlanFirst step Choose a topic. Revi.docxhyacinthshackley2629
"Your Communications Plan"
First step: Choose a topic. Review the Communication Challenge Topics and choose one that is relevant and interesting to you. Make sure to review the examples and anecdotes that follow each topic in this document. You can also find this information under the Course Info tab.
Second step: Review the Strategic Communication Plan example. Your plan should mirror this example in format and length. You can also find this example under the Course Info tab.
Third step: In this discussion, please respond to the following:
Part 1: What is your topic?
Part 2: Provide a rough draft of your Strategic Communications Plan for peer review and instructor feedback. Your draft should include enough detail that we can provide strong constructive feedback and input.
COM510 ASSIGNMENT COMMUNICATION CHALLENGE TOPICS
In the world of business, we can create opportunities through strategic communication. Throughout our professional careers, there are key events that raise the stakes of our communications approach.
WHAT YOU’LL DO
1) Review the Communication Challenge Topics and their accompanying case study examples.
2) Select 1 topic that is professionally relevant for you.
3) Use for your COM510 assignments (the topic you have selected, not the case study example).
Note: If there is another challenge or current opportunity in your professional life that is more relevant for you, you may choose a topic that is not on this list. Keep in mind that the communication challenge you select must in- clude both written and verbal communication elements to meet the needs of this course. (Your professor must approve your selection before you proceed.)
1
Examples of each scenario are provided to demonstrate what thoughtful, professional communication would look like in each of these situations. These are only examples and should not be used for completing the assignment. You can create and establish all necessary assumptions. The scenario is yours to explain.
COMMUNICATION CHALLENGE TOPICS
Choose one of the following topics for your assignments.
• Internal Promotion Opportunity
• New Job Opportunity Interview
• Running a Meeting
• Coaching Your Direct Employees
• Pitching a Project Idea
INTERNAL PROMOTION
Seeking a promotion from within your company is one opportunity in which strategic communication could mean the difference be- tween success and failure. If you choose this scenario, you’ll need to create both a written and a verbal (audio or video) communica- tion. These elements should explain why you are the right person for the internal promotion while addressing potential questions you might need to answer as part of the process.
Things to Consider
• Have you checked the listings on your company’s job board lately?
• Is there a new position you would like to secure?
• Have you taken on more responsibility at work?
• Have your outcomes been positive?
• Do your job title and job description match what you do? .
Your coffee franchise cleared for business in both countries (Mexico.docxhyacinthshackley2629
Your coffee franchise cleared for business in both countries (Mexico, and China). You now have to develop your global franchise team and start construction of your restaurants. . You invite all of the players to the headquarters in the United States for a big meeting to explain the project and get to know one another since they represent the global division of your company.
You are concerned with the following two issues. Substantively address each in a two-part paper, applying Beyond the Book, MUSE, Intellipath and library resources to support your reasoning
Part 1: Effective communication with participants
What are the implications of the cultural variables for your communication with the team representative from each country in the face to face meeting?
Address Hall’s high and low context regarding verbal and non-verbal communication. The United States is a low context culture, while each country is high context.
Tip: Write at least one substantive paragraph for each country
Video on Hall's high and Low Context Communication
Part 2: Effective communication among participants
What are examples of barriers and biases in cross-cultural business communications that may impact the effectiveness of communication among the meeting participants and in potential negotiations?
What are some of the issues you should be concerned about regarding verbal and nonverbal communication for this group to avoid misinterpretations and barriers to communication?
Please submit your assignment.
.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Assessment and Planning in Educational technology.pptxKavitha Krishnan
In an education system, it is understood that assessment is only for the students, but on the other hand, the Assessment of teachers is also an important aspect of the education system that ensures teachers are providing high-quality instruction to students. The assessment process can be used to provide feedback and support for professional development, to inform decisions about teacher retention or promotion, or to evaluate teacher effectiveness for accountability purposes.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
108Electronic cigarettes, or e-cigarettes,” are de-vi.docx
1. 108
E
lectronic cigarettes, or “e-cigarettes,” are de-
vices that consist of a battery-operated ele-
ment which heats a mixture of propylene gly-
col, vegetable glycerin, liquid nicotine and flavor-
ings for the user to inhale. Whereas their overall
safety, as well as their role in smoking cessation, is
the topic of ongoing debate,1 there is no doubt that
the prevalence of e-cigarette use has increased rap-
idly among all age groups.2,3 Among adolescents,
nationally-representative estimates indicate that
past 30-day use for e-cigarettes is higher than con-
ventional cigarettes, and a considerable proportion
of e-cigarette users are dual users of cigarettes.4
That is, a nontrivial number of adolescents—2.2%
of 8th graders, 4.3% of 10th graders and 7.3% of
12th graders— reported using both e-cigarettes and
cigarettes in the past 30 days.4 Several e-cigarette
product features are raising concerns about the
potential to appeal to youth. For example, charac-
teristics such as candy flavorings and easy access
have been implicated as reasons for youth experi-
mentation.5 E-cigarettes also are marketed heavily
on the Internet. A content analysis of e-cigarette
retail websites found frequent appeals to youth
such as use by celebrities, enhanced social activ-
ity, and romance.6
2. Adolescent Dual Product Use
Increasingly, youth who use tobacco products
are using more than one type of product.7,8 Be-
tween 2002 and 2011, rates of poly-tobacco use
increased significantly among users under age 26.9
According to estimates from the National Youth To-
bacco Survey, the majority of current tobacco us-
ers in middle and high school report use of more
than one tobacco product.10,11 Thus, use of mul-
tiple tobacco products by youth is more common
than exclusive use of one product alone. As such,
it is important to understand the correlates asso-
ciated with and characteristics of adolescent us-
ers of multiple tobacco products. To date, evidence
Maria Cooper, Post-doctoral Fellow, Kathleen R. Case, Pre-
doctoral Fellow, MeLisa R. Creamer, Faculty Associate, and
Cheryl L. Perry, Professor and Regional Dean, University of
Texas Health Science Center at Houston, School of Public
Health, Austin Regional Campus, Austin, TX. Alexandra Lou-
kas, Professor, University of Texas at Austin, Department of
Kinesiology and Health Education, Austin, TX.
Contact Dr Loukas; [email protected]
E-cigarette Dual Users, Exclusive Users
and Perceptions of Tobacco Products
Maria Cooper, PhD; Kathleen R. Case, MPH; Alexandra
Loukas, PhD;
MeLisa R. Creamer, PhD; Cheryl L. Perry, PhD
Objectives: We examined differences in
the characteristics of youth non-users,
cigarette-only, e-cigarette-only, and dual
e-cigarette and cigarette users. Methods:
Using weighted, representative data, lo-
3. gistic regression analyses were conducted
to examine differences in demographic
characteristics and tobacco use behav-
iors across tobacco usage groups. Multi-
ple linear regression analyses were con-
ducted to examine differences in harm
perceptions of various tobacco products
and perceived peer use of e-cigarettes by
tobacco usage group. Results: Compared
to non-users, dual users were more likely
to be white, male, and high school stu-
dents. Dual users had significantly higher
prevalence of current use of all products
(except hookah) than e-cigarette-only us-
ers, and higher prevalence of current use
of snus and hookah than the cigarette-
only group. Dual users had significantly
lower harm perceptions for all tobacco
products except for e-cigarettes and hoo-
kah as compared to e-cigarette-only us-
ers. Dual users reported higher peer use
of cigarettes as compared to both exclu-
sive user groups. Conclusion: Findings
highlight dual users’ higher prevalence of
use of most other tobacco products, their
lower harm perceptions of most tobacco
products compared to e-cigarette-only us-
ers, and their higher perceived peer use
of cigarettes compared to exclusive users.
Key words: tobacco use; adolescents;
electronic cigarettes
Am J Health Behav. 2016;40(1):108-116
DOI: http://dx.doi.org/10.5993/AJHB.40.1.12
4. Cooper et al
Am J Health Behav.™ 2016;40(1):108-116 109 DOI:
http://dx.doi.org/10.5993/AJHB.40.1.12
suggests that, in general, adolescents who use 2
or more tobacco products are demographically dis-
tinct from those who use one product. Dual prod-
uct users (in particular, those who use cigarettes
and smokeless tobacco) are more likely to be male
and white than female and non-white.7,12 In ad-
dition, current cigarette/smokeless tobacco dual
product users are more likely to be in high school
than middle school,13 and current cigar/cigarette
dual users are more likely to have a lower grade
point average as compared to non-users.14 Howev-
er, the demographic characteristics of adolescent
dual product e-cigarette and cigarette users are
largely unknown.
The literature describes the deleterious effects of
multiple tobacco product use among adolescents,
including increased nicotine dependence, as well
as increased risk for substance use disorders.7,15,16
However, to date, there is limited research exam-
ining the characteristics of adolescents who use
e-cigarettes and at least one other tobacco prod-
uct. Some studies have explored youth e-cigarette
use with a focus on the prevalence of concomi-
tant cigarette use, motivations for e-cigarette use,
abstinence from cigarettes and intentions to use
other tobacco products,17-20 but with a limited fo-
cus on social-cognitive risk factors. An exception
5. is a study by Wills et al21 that examined current e-
cigarette and cigarette use among high school stu-
dents in Hawaii. The researchers assessed differ-
ences in risk factors and protective factors among
students reporting no tobacco use, exclusive cur-
rent e-cigarette or cigarette use, and dual use.
Findings indicated that risk status varied across
usage groups, with dual users of e-cigarettes and
cigarettes reporting the most risk factors and the
fewest protective factors, and e-cigarette-only us-
ers representing an intermediate category between
non-users and dual users.
Perceptions of Harm and Peer Use of
E-cigarettes
According to the theory of planned behavior, in-
dividuals’ perceptions, including their attitude to-
ward a behavior, normative beliefs, and perceived
control, influence their decision to take part in a
particular behavior.22 Consistent with this theory,
adolescents who use tobacco products are expect-
ed to be less likely to perceive risks from their use
than non-users.23 Therefore, users of multiple to-
bacco products are likely to hold the lowest harm
perceptions as compared to users of only one to-
bacco product and non-users of tobacco; this re-
lationship has been demonstrated already.24 More-
over, adolescent ever smokers who believe it is safe
to smoke are more likely than their peers to use
tobacco products other than cigarettes (smokeless
tobacco, cigars, and bidis).25 However, few studies
have examined harm perceptions as they relate
to adolescents’ use of e-cigarettes, and even fewer
have focused on adolescents who use e-cigarettes
with at least one other tobacco product. This is
6. particularly important given the controversies
around the harmful effects of e-cigarette use,1 and
the need for more substantive research to docu-
ment the potentially harmful effects of e-cigarette
use in adolescence.26
To our knowledge, only 3 studies assess harm
perceptions of e-cigarettes in an adolescent popula-
tion. Amrock et al27 found that several characteris-
tics were associated with adolescents’ perceptions
of e-cigarettes as relatively safer than cigarettes:
being white, using other tobacco products, and
having family members who used tobacco. In ad-
dition, adolescents who had ever used e-cigarettes
perceived them as less harmful than cigarettes,
as compared to those who had never used e-ciga-
rettes. Ambrose et al28 found that whereas one in 3
adolescents believed e-cigarettes were less harm-
ful than cigarettes, the majority of current smokers
(54%) held this belief as compared to fewer of the
ever smokers (41%) and never smokers (25%). Ad-
ditionally, ever use of an e-cigarette had a strong
relationship with perceiving e-cigarettes as less
harmful than cigarettes. In particular, dual users
of e-cigarettes with cigarettes were more than twice
as likely to perceive e-cigarettes as less harmful
compared to exclusive cigarette smokers, and ado-
lescents who used e-cigarettes alone had a 6-fold
increase in their likelihood of perceiving e-ciga-
rettes as less harmful than cigarettes, compared
to adolescents who had never used either product.
Wills et al21 found that current e-cigarette-only us-
ers were more likely to report that e-cigarettes were
a healthy alternative to cigarettes as compared to
non-users, but no differences were found between
7. exclusive e-cigarette and cigarette user groups or
between exclusive e-cigarette and dual use groups.
As stated in the theory of planned behavior, nor-
mative beliefs are influenced by perceptions about
whether others in an individual’s social network
perform the behavior of interest.22 Prior research
demonstrates that peers have a strong influence
on both adolescents’ initiation and escalation in
cigarette use.29 Interestingly, perceived prevalence
of smoking rather than actual prevalence of peer
smoking is associated with an increased risk of
smoking among youth.30 There are few published
articles, however, that describe peer use in relation
to youth use of tobacco products other than ciga-
rettes. The limited evidence suggests that having
peers who used other tobacco products or expo-
sure to peer smoking are both significant predic-
tors of adolescent use of alternative tobacco prod-
ucts such as cigars, smokeless tobacco, bidis and
kreteks.25,12 Wills et al21 reported that among high
school students, perceptions of peer smoking dif-
fered according to tobacco usage group. Perceived
peer smoking was higher among exclusive e-cig-
arette users as compared to non-users as well as
higher among dual users as compared to exclusive
e-cigarette users. No differences were found for
peer smoking between e-cigarette-only and ciga-
rette-only groups.
E-cigarette Dual Users, Exclusive Users and Perceptions of
Tobacco Products
110
8. According to the Campaign for Tobacco-free Kids,
Texas ranks 32nd out of 50 US states in prevalence
of conventional cigarette smoking among high
school students.31 Additionally, our 2015 paper
showed that e-cigarette use was higher in Texas
than both national estimates and those document-
ed in other states.32 Furthermore, Texas receives
more tobacco industry marketing dollars than
any other state except California33 and ranks 40th
among states in spending for tobacco prevention.34
Therefore, youth in Texas, who represent 9.6% of
all US youth,35 are a vulnerable population, mak-
ing the state an important backdrop to understand
characteristics and perceptions associated with to-
bacco use in adolescents.
The purpose of the current study was to exam-
ine Texas adolescents’ harm perceptions of various
tobacco products and perceived peer use of e-cig-
arettes based on usage group. There were 3 aims.
First, we examined pairwise differences among 4
usage groups—non-cigarette and non-e-cigarette
users, cigarette-only users, e-cigarette-only users
and dual users—in their demographic character-
istics and tobacco use behaviors. Second, we ex-
amined pairwise differences among the 4 usage
groups in perceptions about the harms of various
tobacco products and alcohol use, as well as per-
ceived peer use of tobacco products. Third, we ex-
amined differences in cigarette harm perceptions
and e-cigarette harm perceptions by usage group.
We hypothesized that dual users would more likely
be older, white, and male as compared to other us-
age groups. We also hypothesized that dual users
would have higher rates of perceived peer use as
9. well as lower reported rates of perceived harm for
all tobacco products. This study furthers under-
standing of perceptions of tobacco products and
peer use among both exclusive and dual users of
e-cigarettes and cigarettes.
METHODS
Participants
Participants were 13,602 6th through 12th grade
students attending 69 public schools in 27 coun-
ties in Texas; 49.9% were female; 43.9% were non-
Hispanic Whites, 5.8% were African Americans,
41.1% were Hispanics, and 9.2% reported another
ethnicity.
Procedure
Data were drawn from the 2014 Texas Youth To-
bacco Survey, which sampled students from pub-
lic school districts across the state. Recruitment of
schools occurred in one of 2 ways: (1) school dis-
tricts in 12 “coalition” counties involved in a state-
funded tobacco prevention and control project
were recruited to participate in the study; of the 65
school districts in these counties, 23 participated
(N = 52 schools); and (2) proportional probability
sampling (recruitment probability is proportional
to size of the school) was used to recruit an ad-
ditional 17 schools from 15 additional counties.
The school response rate was 25%, whereas stu-
dent participation rate was 87%. In spring 2014,
13,602 students voluntarily completed the 38-item
anonymous survey, either via paper-and-pencil (N
= 59 schools) or online (N = 10 schools), in their
10. classrooms during class time.
Measures
Tobacco use categories. To generate cat-
egories of current tobacco use, responses from 2
items adapted from the Centers for Disease Con-
trol and Prevention’s (CDC) 2013 National Youth
Tobacco Survey were analyzed: (1) “During the
past 30 days, on how many days did you use elec-
tronic cigarettes or e-cigarettes, such as Ruyan or
NJOY?” and (2) During the past 30 days, on how
many days did you smoke cigarettes?” From these
2 items, 4 usage groups were generated: non-users
of e-cigarettes or cigarettes; e-cigarette-only users;
cigarette-only users; and e-cigarette and cigarette
dual users. Participants who reported not using
either product during the past 30 days were clas-
sified as non-users of e-cigarettes or cigarettes,
participants who reported using e-cigarettes at
least one day during the past 30 days and re-
ported using cigarettes zero days during the past
30 days were classified as e-cigarette-only users,
participants who reported using e-cigarettes zero
days during the past 30 days and reported using
cigarettes on at least one day during the past 30
days were classified as cigarette-only users, and
participants who reported using both products on
at least one day during the past 30 days were clas-
sified as e-cigarette and cigarette dual users.
Other current and lifetime tobacco use. Cur-
rent and lifetime use of other tobacco products in-
cluding chew, snus, hookah and flavored tobacco
products also was analyzed. For each of the tobac-
11. co products, students reporting at least one day
of other tobacco product use in the past 30 days
were classified as current users, and those who
reported ever using a tobacco product were clas-
sified as lifetime users. Lifetime use of e-cigarettes
and of cigarettes also was included; thus, students
reporting ever using those products were classified
as lifetime users.
Harm perceptions of tobacco products and
alcohol. To measure harm perceptions for various
products, respondents are asked: “How dangerous
do you think it is for a person your age to use: (1)
Cigarettes; (2) Chewing tobacco, snuff, or dip, such
as Redman, Levi Garrett, Beechnut, Skoal, Skoal
Bandits, or Copenhagen; (3) Snus, such as Skoal,
General, Camel or Marlboro Snus; (4) Tobacco in a
hookah or a water pipe; (5) Electronic cigarettes or
e-cigarettes, such as Ruyan or NJOY; (6) Tobacco
products that are flavored; (7) Alcohol.” Response
options are given on a 4-point scale, and include:
“very dangerous, somewhat dangerous, not very
dangerous, and not dangerous at all.” Responses
were reverse coded from “not dangerous at all” (1)
to “very dangerous” (4).
Cooper et al
Am J Health Behav.™ 2016;40(1):108-116 111 DOI:
http://dx.doi.org/10.5993/AJHB.40.1.12
Perceived peer use of tobacco products. To
measure perceived peer use for various products,
respondents are asked: “About how many of your
12. closest friends: 1) Smoke cigarettes? (2) Use chew-
ing tobacco, snuff or dip such as Redman, Levi
Garrett, Beechnut, Skoal, Skoal Bandits, or Co-
penhagen? (3) Electronic cigarettes or e-cigarettes,
such as Ruyan or NJOY?“ Response options are
given on a 6-point scale, and include: “none, a few,
some, most, all, not sure.” Respondents who chose
“not sure” were removed from the analysis on peer
use. Therefore, responses ranged from “none” (0)
to “all” (4).
Data Analysis
Logistic regression analyses were used to ex-
amine differences in demographic characteristics,
grades in school, and tobacco use behaviors across
usage groups. Demographic characteristics, grades
in school, and tobacco use behaviors served as the
dependent variables, while usage group served
as the independent variable. All dependent vari-
Table 1
Demographic Characteristics in Usage Groups (Logistic
Regression
Analyses) — 2014 Texas Youth Tobacco Survey
Non-e-cigarette/
Cigarette Users
(N = 11,431)
E-cigarette-only Users
(N = 638)
Cigarette-only Users
13. (N = 474)
Dual Users
(N = 761)
Overall (%) 82.2 6.38 3.87 7.55
Sex
% Female 52.06 50.76 43.51 28.99a
% Male 47.94 49.24 56.49 71.01a
School Level
% Middle School 49.54 32.58 31.05a 19.36a,c
% High School 50.46 67.42 68.95a 80.64a,c
Race/Ethnicity
% White 42.22 47.11 44.71 58.12a,c
% Black 6.39 2.29 9.49 1.96
% Hispanic 43.12 35.36 33.10 27.08a,b
% Other 8.27 15.24 12.70 12.84
Mean Gradesd 3.14 3.13 2.52a,b 2.83a
Current Tobacco Use
% Chew 1.88 22.55a 41.12a 52.47a,b
% Snus 0.45 10.15a 15.20a 47.33a,b,c
% Hookah 1.86 45.40a 17.04 54.26a,c
% Flavored 1.67 38.23a 37.93a 64.82a,b
Lifetime Use
% E-cigarette 9.15 -- 55.03a --
14. % Cigarette 12.45 54.78a -- --
% Chew 7.12 30.81a 50.65a 60.61a,b
% Snus 2.56 21.41a 37.93a 53.88a,b
% Hookah 5.49 60.02a 32.32a 59.87a
% Flavored 6.86 56.64a 60.33a 76.74a
Note.
a Significantly different from Non-e-cigarette/Cigarette users,
p < .05
b Significantly different from E-cigarette-only users, p < .05
c Significantly different from Cigarette-only users, p < .05
d Measured on 0 to 4 scale, from “Mostly Fs” to “Mostly As”;
ANOVA conducted to determine differences in mean
grades
E-cigarette Dual Users, Exclusive Users and Perceptions of
Tobacco Products
112
ables were dichotomized using dummy variables,
and separate regression models were conducted
for each of the dependent variables. Results were
adjusted to account for multiple comparisons us-
ing the Bonferroni correction. Additionally, one-
way analysis of variance (ANOVA) was conducted
to determine differences in mean grades in school
across the 4 usage groups. Multiple linear regres-
sion analyses were conducted to examine differ-
ences in harm perceptions and perceptions of peer
use by usage groups, adjusting for age, sex, and
15. race/ethnicity. Pairwise comparisons using the
Bonferroni correction were obtained post-estima-
tion to determine differences in harm perceptions
and perceived peer use between: (1) non-users of
e-cigarettes and cigarettes versus dual users; (2)
e-cigarette-only users versus dual users; and (3)
cigarette-only users versus dual users. Finally, to
examine differences in cigarette harm perceptions
and e-cigarette harm perceptions by usage group,
multiple linear regression analyses were conducted
to generate mean harm perceptions for each of the
usage groups. Multiple linear regression analyses
also were performed to determine the difference in
mean by each current usage group and to test if
the difference was significantly different from zero.
Analyses were adjusted for age, sex, and race/eth-
nicity.
All analyses were conducted using state sam-
pling weights, and school level clustering was ac-
counted for by including schools as the cluster
variable in regression models, thereby making the
study representative of schools in Texas. Whereas
the overall sample size was 13,602, the sample
sizes varied for each model due to missing data,
which ranged from 0.8% to 2.3% for the included
variables.
RESULTS
Differences across 4 Usage Groups in
Demographic Characteristics and Tobacco Use
Behaviors
The majority of participants (82.2%) were non-
users of either product. Nearly 8% were dual us-
ers, over 6% were e-cigarette-only users and close
16. to 4% were cigarette-only users. As Table 1 shows,
dual users were significantly more likely to be
male than non-users. The proportion of dual users
in high school was significantly higher than the
proportions of cigarette-only and non-user groups
in high school (versus middle school). Dual users
were more likely to be white than both the ciga-
rette-only and non-user groups. Non-users were
more likely to be Hispanic than dual users (but
not more likely than the e-cigarette-only or cig-
arette-only groups). In addition, differences were
Table 2
Adjusted Means (SE) for Variables across Usage Groups with
Regression
Coefficients from Multiple Linear Regression—2014 Texas
Youth Tobacco Survey
Non-e-cigarette/
Cigarette Users
(N = 11,431)
E-cigarette-
only Users
(N = 638)
Cigarette-
only Users
(N = 474)
Dual
Users
(N = 761)
18. Chew 0.58 (.02) 1.11 (.15) 1.60 (.26) 1.71 (.09) -1.13*** -
0.60 -0.11
*p < .05, **p < .01, ***p < .001
Note.
a Measured on a 1 to 4 scale from “not dangerous at all” to
“very dangerous”
b Measured on a 0 to 4 scale from “none” to “all”
Analyses adjusted for age, sex and race/ethnicity, using state
sampling weights and accounting for school-level clustering;
results adjusted for multiple comparisons using Bonferroni
adjustment
Cooper et al
Am J Health Behav.™ 2016;40(1):108-116 113 DOI:
http://dx.doi.org/10.5993/AJHB.40.1.12
found among usage groups for self-reported aca-
demic performance in the last school year. Both
non-users and e-cigarette-only users had higher
mean grades than the cigarette-only group, and
the non-user group had higher mean grades than
the dual user group.
Significant differences in prevalence of other
tobacco product use were found across all cate-
gories of products. Non-users differed from all 3
usage groups, and had the lowest prevalence of
current and lifetime use other tobacco products
with one exception being no significant difference
between non-users and cigarette-only users in
current hookah use. Current and lifetime use of
19. other products was not significantly different be-
tween e-cigarette-only and cigarette-only groups.
Dual users did not differ from cigarette-only users
on lifetime use of any tobacco product. However,
lifetime prevalence estimates for chew (60.6%) and
snus (53.9%) were higher among dual users than
e-cigarette-only users and non-users. Moreover,
dual users had higher prevalence of current use of
all products (except hookah) than e-cigarette-only
users, as well as significantly higher prevalence of
current use of snus (47.3%) and hookah (54.3%)
than the cigarette-only group.
Harm Perceptions and Peer Use across Usage
Groups
As Table 2 shows, significant differences were
found in the perceptions of harm of tobacco prod-
ucts and alcohol use among usage groups. Non-
users were significantly more likely to rate all
tobacco products and alcohol use as more harm-
ful than did the dual use group. The e-cigarette-
only group perceived cigarettes as more harmful,
when compared to the dual user group, and the
cigarette-only group rated e-cigarettes significantly
more harmful than the dual use group. There were
similar patterns of differences in perceptions of
harm for both chew and snus. The e-cigarette-only
group perceived both products as more harmful
than the dual use group, whereas no differences
were seen between the cigarette-only group and
the dual use group. No significant differences were
found between e-cigarette-only users or cigarette-
only users and dual users in their perceptions of
harm of hookah. Similar patterns also were seen
20. in perceptions of harm for general tobacco and al-
cohol. Whereas no differences were found between
the cigarette-only group and the dual user group,
e-cigarette-only users were more likely to rate both
general tobacco and alcohol use as more harmful
than the dual user group.
Regarding peer use, there were significant dif-
ferences between groups on perceived peer use of
cigarettes, e-cigarettes and chew (Table 2). Dual
users perceived higher peer use of all products as
compared to non-users. Dual users also perceived
higher peer use of cigarettes as compared to both
the e-cigarette-only and cigarette-only groups. No
differences were seen in perceived peer use of ei-
ther e-cigarettes or chew between dual users and
exclusive user group comparisons.
Comparisons in Harm Perceptions of
Cigarettes and E-cigarettes within Usage
Groups
Comparisons of cigarette and e-cigarette harm
perceptions by tobacco usage group are displayed
in Table 3.The mean harm perceptions score was
significantly higher for cigarettes than for e-ciga-
rettes among all usage groups. The difference in
mean harm perceptions between cigarettes and e-
cigarettes was 0.46 (p < .001) for non-users, 1.44
(p < .001) for e-cigarette-only users, 0.55 (p = .003)
for cigarette-only users, and 0.89 (p < .001) for
dual users.
Table 3
Comparison of Cigarette and E-cigarette Harm Perceptions by
Usage Group
21. (Multiple Linear Regression Analyses) —2014 Texas Youth
Tobacco Survey
Cigarette Harm
Perceptionsa
Mean (SE)
E-cigarette Harm
Perceptionsa
Mean (SE)
Differenceb
Mean (SE)
Use Behavior
Non- e-cigarette/Cigarette Users N = 11,020) 3.59 (.02) 3.13
(.04) 0.46 (.02) p < .001
E-cigarette-only Users (N = 611) 3.53 (.11) 2.09 (.08) 1.44
(.07), p < .001
Cigarette-only Users (N = 448) 3.03 (.06) 2.48 (.14) 0.55
(.18), p = .003
Dual Users (N = 729) 2.80 (.07) 1.91 (.07) 0.89 (.11) p <
.001
Note.
a measured on a 1 to 4 scale from “not dangerous at all” to
“very dangerous”
b Cigarette- e-cigarette Harm Perceptions
Analyses adjusted for age, sex and race/ethnicity, using state
sampling weights and accounting for school-level clustering
Means presented in Table 3 differ slightly from those is Table 2
as a result of differences in sample size due to missing data
E-cigarette Dual Users, Exclusive Users and Perceptions of
22. Tobacco Products
114
DISCUSSION
The current study adds to the limited body of
literature describing patterns of e-cigarette use
among middle and high school students, percep-
tions of harm, and peer use for these relatively new
products whose prevalence of use is on the rise,
as well as other types of tobacco products. Find-
ings from the 2014 Texas Youth Tobacco Survey
confirm results from other studies on the emerging
patterns of e-cigarette use among youth, showing
that a large number of youth are using e-cigarettes
only, and many are using e-cigarettes in conjunc-
tion with conventional cigarettes.2,4
Findings highlight demographic differences
based on usage group. Interestingly, non-users
and e-cigarette-only users did not differ on any
of the sociodemographic characteristics we exam-
ined. Dual users had the most differences across
groups. They were more likely to be male, older,
white, and have lower mean grades than non-
users. They were also more likely to be older and
white compared to the cigarette-only group. Dual
users consistently had the highest prevalence of
other tobacco product use, except for lifetime hoo-
kah use, indicating that teens using both e-ciga-
rettes and cigarettes are more likely to use other
types of products, such as chew, snus and any fla-
vored product.
Across the various tobacco products, harm per-
23. ceptions differed among usage groups. For exam-
ple, e-cigarette-only users viewed conventional cig-
arettes as more harmful than the dual user group.
This is a novel finding that has not been reported
previously in the literature. The same pattern was
not seen for e-cigarettes, however. Interestingly,
there were no differences in how harmful the e-
cigarette-only and the dual user groups rated e-
cigarettes, however, the cigarette-only group rated
e-cigarettes as more harmful than the dual user
group. This study differs from one performed by
Wills et al21 in that it measures absolute harm of
e-cigarettes rather than relative harm compared
to cigarettes; our results follow similar trends. For
example, no differences in perceived harmfulness
of e-cigarettes were found between e-cigarette-
only and dual user groups. Findings also gener-
ally confirm results from studies by Amrock et al27
and Ambrose et al28 that found that adolescents
who use e-cigarettes perceive them as less harmful
than those who do not. Consistent with Ambrose
et al,28 dual users in our sample were more likely
to perceive e-cigarettes as less harmful compared
to exclusive cigarette smokers, and in terms of dif-
ferences between harm perceptions of e-cigarettes
and cigarettes, our results also generally align with
the finding that the highest risk of perceiving e-
cigarettes as less harmful than cigarettes was held
by the exclusive e-cigarette users. Specifically, al-
though the current study found that all 4 usage
groups rated cigarettes as more harmful than e-
cigarettes, the magnitude of the difference in harm
perceptions was greatest for the e-cigarette-only
users followed by the dual users. These findings
are consistent with the theory of planned behav-
24. ior.22 According to the theory, dual users would
perceive e-cigarettes to be less harmful than non-
users and cigarette-only users, which may be why
they would use them. Students who perceive e-cig-
arettes as more harmful would be less likely than
their counterparts to initiate use of these products.
Another striking finding was that harm percep-
tions for hookah followed the same pattern as that
of e-cigarettes in that, unlike all other tobacco
product comparisons, perceptions of harm did
not differ between e-cigarette-only and dual user
groups. Few studies offer explanation as to why
perceptions of harm may be similar for both prod-
ucts. One study, however, highlighted a connec-
tion between e-cigarette and hookah use, finding
that adolescent e-cigarette-only users were more
likely than cigarette smokers to use hookah.19
Given the limited evidence, we can only specu-
late that similar ratings of harmfulness between
e-cigarettes and hookah may be related to both
products having a multitude of available flavorings
or similarities between the sensation of inhaling
e-cigarette aerosol and hookah smoke which has
been cooled by the water pipe. For perceptions of
chew and snus, group comparisons were gener-
ally consistent with prior literature that has found
that perceived risk of harm for smokeless tobacco
varied by the tobacco product use groups, with a
higher proportion of nonsmokers perceiving great
risk of harm.36
Our results on perceived peer cigarette smoking
are consistent with Wills et al’s21 finding that dif-
ferences exist between exclusive e-cigarette users
and dual users. Perceived peer use of e-cigarettes
25. and chew differed only between non-users and
dual users, a finding that has not been reported
previously. Consistent with the theory of planned
behavior, students who perceive higher levels of
peer use are more likely to use tobacco products.22
These findings highlight the need to better under-
stand the role of peers in adolescents’ e-cigarette
use.
Limitations
This study is subject to at least 3 limitations.
First, the cross-sectional design precludes us from
making causal inferences about the findings. Sec-
ond, the study participants are limited to Texas
youth; therefore, findings may not be generalizable
to populations outside of the sample. Finally, the
survey item on flavored tobacco products does not
make a distinction between types of product. Fur-
thermore, it unknown whether adolescents con-
sider e-cigarettes to be tobacco products.
Conclusion
This study provides demographic characteristics
of adolescents who were exclusive e-cigarette us-
ers, exclusive cigarette users, and dual users of
cigarettes and e-cigarettes, a novel contribution to
Cooper et al
Am J Health Behav.™ 2016;40(1):108-116 115 DOI:
http://dx.doi.org/10.5993/AJHB.40.1.12
26. the field. Our findings confirm in many ways what
we know about harm perceptions and tobacco use,
that is, using a tobacco product is tied strongly
to believing that it is less harmful than those who
choose not to use the product. However, our find-
ings also offer a new understanding of how tobac-
co usage groups rate the harmfulness of various
tobacco products. Dual users were more likely to
have lower harm perceptions as compared to ex-
clusive e-cigarette users for all tobacco products
except for e-cigarettes and hookah, and they dif-
fered from the cigarette-only group only in their
harm perceptions of e-cigarettes, which they rated
as less harmful. Dual users also were more likely
to perceive higher peer use of cigarettes than the
non-users and both exclusive user groups. Within
the 4 tobacco usage groups, the e-cigarette-only
users had the largest difference in their percep-
tions of e-cigarettes as less harmful than ciga-
rettes.
Implications for Practice and Policy
The Family Smoking Prevention Tobacco Control
Act (2009) permitted the US Food and Drug Ad-
ministration (FDA) to regulate cigarettes, smoke-
less tobacco, and roll-your-own tobacco; however,
the FDA also has the authority to regulate other
products. In 2014, the FDA proposed to deem oth-
er tobacco products, including e-cigarettes, within
its purview. Findings in this study indicate that
other tobacco products, including e-cigarettes, are
popular among youth, and provide additional sci-
entific evidence to support the need for these prod-
ucts to be regulated by the FDA. Our study’s re-
sults also provide important implications for pub-
27. lic health practice. Interventions should include
the full spectrum of tobacco products as students
in our sample who used e-cigarettes were more
likely to perceive e-cigarettes as less harmful and
more likely to think their peers used e-cigarettes
and smokeless tobacco. Therefore, interventions
should provide information regarding the harm-
fulness of e-cigarettes and focus on changing the
normative beliefs associated with these products.
Human Subjects Statement
This study’s procedures have been approved by
Texas A&M University’s Institutional Review Board
- Human Subjects in Research.
Conflict of Interest Disclosure Statement
None of the authors has any competing interests.
Acknowledgements
The authors acknowledge the investigators and
staff members at Texas A&M University’s Public
Policy Research Institute who conducted the Tex-
as Youth Tobacco Survey in conjunction with the
Texas Department of State Health Services. Study
authors were supported by grant number [1 P50
CA180906-01] from the National Cancer Insti-
tute at the National Institutes of Health and the
Food and Drug Administration, Center for Tobacco
Products (CTP). The content is solely the responsi-
bility of the authors and does not necessarily rep-
resent the official views of the National Institutes of
Health or the Food and Drug Administration.
28. References
1. Cobb NK, Byron MJ, Abrams DB, Shields PG. Novel nico-
tine delivery systems and public health: the rise of the
“e-cigarette.” Am J Public Health. 2010;100(12):2340-
2342.
2. Arrazola R, Singh T, Corey CG, et al. Tobacco use among
middle and high school students- United States, 2011-
2014. MMWR Morb Mortal Wkly Rep. 2015;64(14):381-
385.
3. King BA, Patel R, Nguyen KH, Dube SR. Trends in aware-
ness and use of electronic cigarettes among U.S. adults,
2010-2013. Nicotine Tob Res. 2015;17(2):219-227.
4. Monitoring the Future 2014. National Results on Adoles-
cent Drug Use: Overview of Key Findings. Ann Arbor, MI:
Institute for Social Research, The University of Michigan;
2015.
5. Kong G, Morean ME, Cavallo DA, et al. Reasons for elec-
tronic cigarette experimentation and discontinuation
among adolescents and young adults. Nicotine Tob Res.
2015;17(7):847-854.
6. Grana RA, Ling PM. “Smoking revolution”: a content
analysis of electronic cigarette retail websites. Am J Prev
Med. 2014;46(4):395-403.
7. Everett SA, Malarcher AM, Sharp DJ, et al. Relationship
between cigarette, smokeless tobacco, and cigar use,
and other health risk behaviors among U.S. high school
students. J School Health. 2000;70(6):234-240.
8. Soldz S, Huyser DJ, Dorsey E. Characteristics of users
29. of cigars, bidis, and kreteks and the relationship to ciga-
rette use. Prev Med. 2003;37(3):250-258.
9. Fix BV, O’Connor RJ, Vogl L, et al. Patterns and correlates
of polytobacco use in the United States over a decade:
NSDUH 2002-2011. Addict Behav. 2014;39(4):768-781.
10. Apelberg BJ, Backinger CL, Curry SJ. Enhancing youth
tobacco surveillance to inform tobacco product regula-
tion: findings from the 2012 National Youth Tobacco
Survey. Am J Prev Med. 2014;47(2 Suppl 1):S1-S3.
11. Nasim A, Blank MD, Cobb CO, et al. Patterns of alter-
native tobacco use among adolescent cigarette smokers.
Drug Alcohol Depend. 2012;124(1-2):26-33.
12. Tercyak K. Psychosocial correlates of alternate tobac-
co product use during early adolescence. Prev Med.
2002;35(2):193-198.
13. Tomar SL, Alpert HR, Connolly GN. Patterns of dual
use of cigarettes and smokeless tobacco among US
males: findings from national surveys. Tob Control.
2010;19(2):104-109.
14. Brooks A, Larkin EM, Kishore S, et al. Cigars, cigarettes,
and adolescents. Am J Health Behav. 2008;32(6):640-
649.
15. Post A, Gilljam H, Rosendahl I, et al. Symptoms of nico-
tine dependence in a cohort of Swedish youths: a com-
parison between smokers, smokeless tobacco users and
dual tobacco users. Addiction. 2010;105(4):740-746.
16. Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, et al. Youth
tobacco use type and associations with substance use
30. disorders. Addiction. 2014;109(8):1371-1380.
17. Dutra LM, Glantz SA. Electronic cigarettes and conven-
tional cigarette use among US adolescents: a cross-sec-
tional study. JAMA Pediatr. 2014;168(7):610-617.
18. Bunnell RE, Agaku IT, Arrazola RA, et al. Intentions
to smoke cigarettes among never-smoking U.S. middle
and high school electronic cigarette users, National
Youth Tobacco Survey, 2011-2013. Nicotine Tob Res.
2015;17(2):228-235.
E-cigarette Dual Users, Exclusive Users and Perceptions of
Tobacco Products
116
19. Camenga DR, Kong G, Cavallo DA, et al. Alternate to-
bacco product and drug use among adolescents who use
electronic cigarettes, cigarettes only, and never smokers.
J Adolesc Health. 2014;55(4):588-591.
20. Camenga DR, Delmerico J, Kong G, et al. Trends in use
of electronic nicotine delivery systems by adolescents.
Addict Behav. 2014;39(1):338-340.
21. Wills TA, Knight R, Williams RJ, et al. Risk factors for
exclusive e-cigarette use and dual e-cigarette use and
tobacco use in adolescents. Pediatrics. 2015;135(1):e43
-e51.
22. Montaño D, Kasprzyk D. Theory of reasoned action, the-
ory of planned behavior, and the integrated behavioral
model. In Glanz K, Rimer BK, Viswanath K, eds. Health
31. Behavior: Theory, Research, and Practice. 5th ed. San
Francisco, CA: Jossey-Bass; 2015:95-124.
23. Benthin A, Slovic P, Severson H. A pyschometric study of
adolescent risk perception. J Adolesc. 1993;16:153-168.
24. Latimer LA, Batanova M, Loukas A. Prevalence and harm
perceptions of various tobacco products among college
students. Nicotine Tob Res. 2014;16(5):519-526.
25. Gilpin EA, Pierce JP. Concurrent use of tobacco products
by California adolescents. Prev Med. 2003;36(5):575-
584.
26. Durmowicz EL. The impact of electronic cigarettes on the
paediatric population. Tob Control. 2014;23 Suppl 2:ii41-
46.
27. Amrock SM, Zakhar J, Zhou S, et al. Perception of e-
cigarettes’ harm and its correlation with use among U.S.
adolescents. Nicotine Tob Res. 2015;17(3):330-336.
28. Ambrose BK, Rostron BL, Johnson SE, et al. Perceptions
of the relative harm of cigarettes and e-cigarettes among
U.S. youth. Am J Prev Med. 2014;47(2 Suppl 1):S53-S60.
29. Li C, Pentz MA, Chou CP. Parental substance use as a
modifier of adolescent substance use risk. Addiction.
2002;97:1537-1550.
30. Ellickson PL, Bird CE, Orlando M. Social context and
adolescent health behavior: does school-level smoking
prevalence affect students’ subsequent smoking behav-
ior? J Health Soc Behav. 2003(44):525–535.
32. 31. Campaign for Tobacco-free Kids. Toll of tobacco in the
United States. Available at: http://www.tobaccofreekids.
org/what_we_do/state_local/. Accessed September 17,
2015.
32. Cooper M, Case KR, Loukas A. E-cigarette use among
Texas youth: results from the 2014 Texas Youth Tobacco
Survey. Addict Behav. 2015;50:173-177.
33. Campaign for Tobacco-free Kids. State-specific estimates
of tobacco company marketing expenditures, 1998-
2012. Available at: https://www.tobaccofreekids.org/
research/factsheets/pdf/0271.pdf. Accessed September
17, 2015.
34. Campaign for Tobacco-Free Kids. Spending on tobacco
prevention: Texas. Available at: https://www.tobacco-
freekids.org/microsites/statereport2015/texas.html.
Accessed September 17, 2015.
35. The Annie E. Casey Foundation. KIDS COUNT data cen-
ter. Available at: datacenter.kidscount.org. Accessed
September 17, 2015.
36. Tomar SL, Hatsukami DK. Perceived risk of harm from
cigarettes or smokeless tobacco among U.S. high school
seniors. Nicotine Tob Res. 2007;9(11):1191-1196.
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Refer to the below table, The number of health plans with an
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34. page.
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best ways to ensure that you and your family will get the care,
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your plan to see if they have applied for and received NCQA
Accreditation. If a plan chooses not to be reviewed by NCQA,
you should ask: Why not?
If you receive health care coverage through your employer, talk
with them about offering NCQA-accredited plans. Health plans
are more likely to focus on quality and seek accreditation if
encouraged to do so by health plan members and employers who
make decisions about which plans to choose.
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care coverage to individuals and families.
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health plan has received. Types include First, Interim, Renewal
(Health Plan Accreditation 2013), and Health Plan Accreditation
(Before 2013).
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Indicates whether this Accreditation is scored based on HEDIS
results.
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Indicates whether this Accreditation is scored based on CAHPS
results.
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35. provide health care coverage to a certain population or group of
people. NCQA divides plan type by Commercial, Medicare, and
Medicaid.
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An Accredited Product is the type of health plan offered by
different health care organizations. NCQA divides Accredited
Product by HMO, POS and PPO.
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Accreditation a plan has received. NCQA Accreditation is a
thorough and rigorous evaluation of a health plan for quality
measurement and continuous quality improvement by NCQA.
What’s new about accreditation scoring?
A change to NCQA’s accreditation scoring methodology that we
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The change is the elimination of the "sampling variation scoring
adjustment." That is NCQA’s practice from 1999 (when we
incorporated performance measurement into accreditation) of
adding five extra points to HEDIS and CAHPS results. Given
that we have added more measures over time and the
performance on those measures has become more stable, we
announced that we no longer need this scoring adjustment. We
also note that health plans have raised their performance over
time. By phasing out the scoring adjustment, NCQA is raising
the bar in order to drive further improvement. For more
information visit www.ncqa.org/Accreditation_Scoring.
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serve. If your plan is not listed, be sure to review the list of
additional names your health plan may use to see if it is
included under a different name on our report card. Additional
plan names are listed under the plan name on the search results
36. page.
2. Some health plans choose not to participate in NCQA’s
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your plan to see if they have applied for and received NCQA
Accreditation. If a plan chooses not to be reviewed by NCQA,
you should ask: Why not?
If you receive health care coverage through your employer, talk
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are more likely to focus on quality and seek accreditation if
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make decisions about which plans to choose.
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Select
All
Plan Name ?
Accreditation Type ?
Organization Type ?
Product ?
Scored on HEDIS? ?
Scored on CAHPS? ?
Overall Accreditation
Status ?
AMERIGROUP Maryland, Inc.
Amerigroup Maryland
Health Plan Accreditation
Medicaid
HMO
37. Yes
Yes
Commendable
Jai Medical Systems Managed Care Organization, Inc.
Inc.;Jai Medical Systems Managed Care Organization
Health Plan Accreditation
Medicaid
HMO
Yes
Yes
Excellent
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
HealthChoice;HealthChoice (Maryland Medicaid)
Health Plan Accreditation
Medicaid
HMO
Scheduled
Maryland Care Inc., d/b/a/ Maryland Physicians Care
Maryland Physicians Care
Health Plan Accreditation
Medicaid
HMO
No
No
Interim
MedStar Family Choice, Inc.
MedStar Family Choice
Health Plan Accreditation
Medicaid
HMO
38. Yes
Yes
Commendable
Priority Partners MCO
Health Plan Accreditation
Medicaid
HMO
Yes
Yes
Commendable
Riverside Health of Maryland, Inc.
Riverside Health of Maryland
Health Plan Accreditation
Medicaid
HMO
No
No
Interim
UnitedHealthcare of the Mid-Atlantic, Inc. - Medicaid
United Healthcare Community Plan
Health Plan Accreditation
Medicaid
HMO
Yes
Yes
Accredited
Aetna Health Inc. (Pennsylvania) - Maryland
Aetna Medicare Plan (HMO)
Health Plan Accreditation
Medicare
HMO
Yes
39. Yes
Accredited
Aetna Life Insurance Company (MD/DC)
Aetna MedicareSM Plan (PPO)
Health Plan Accreditation
Medicare
PPO
Yes
Yes
Commendable
Cigna-HealthSpring Mid-Atlantic, Inc.
Achieve/Achieve Plus;Bravo Achieve;Bravo Choice;Bravo
Classic;Bravo Gold;Bravo Premier Plus;Bravo Select;Bravo
Traditions;Preferred/Preferred Plus;TotalCare;Traditions
Health Plan Accreditation
Medicare
HMO
Yes
Yes
Accredited
Humana Insurance Company (Ohio)
Humana Insurance Company
Health Plan Accreditation
Medicare
PPO
Yes
Yes
Commendable
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
KP Medicare Plus (Cost) Plan;KP Medicare Plus Plan;Signature
Health Plan Accreditation
Medicare
40. HMO
Yes
Yes
Excellent
UnitedHealthCare Insurance Company (IN)
AARP MedicareComplete Choice (PPO);AARP
MedicareComplete Choice Plan 2 (PPO);UnitedHealthcare
Group Medicare Advantage (PPO)
Health Plan Accreditation
Medicare
PPO
Yes
Yes
Commendable
Bottom of Form
Original investigatiOn
e-Cigarette awareness, Use, and Harm Perceptions in
italy: a national representative survey
Silvano Gallus ScD1, Alessandra Lugo ScD2, Roberta Pacifici
ScD3, Simona Pichini PhD3,
Paolo Colombo ScD4, Silvio Garattini MD1, Carlo La Vecchia,
MD2
1Department of Epidemiology, IRCCS – Istituto di Ricerche
Farmacologiche Mario Negri, Milan, Italy; 2Department of
41. Clinical
Sciences and Community Health, Università degli Studi di
Milano, Milan, Italy; 3Department of Therapeutic Research and
Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy;
4Istituto DOXA, Worldwide Independent Network/Gallup
International Association, Milan, Italy
Corresponding Author: Silvano Gallus, ScD, Department of
Epidemiology, IRCCS – Istituto di Ricerche Farmacologiche
Mario Negri, Via G. La Masa 19, 20159 Milan, Italy.
Telephone: 390239014657; Fax: 390233200231; E-mail:
[email protected]
marionegri.it
Received December 12, 2013; accepted June 21, 2014
abstraCt
introduction: Only a few studies have provided information on
awareness, use, and harm perceptions of e-cigarettes in Europe.
We fill the knowledge gap in Italy.
Methods: We used data from a face-to-face survey conducted in
2013 of a sample of 3,000 individuals, representative of the
Italian population aged ≥15 years (51.1 million inhabitants).
results: Awareness of e-cigarettes was 91.1%; it was lowest
among women (87.8%), the elderly (78.4%), those with less
education (84.1%), and never-smokers (89.0%). Ever e-cigarette
use was 6.8% overall and was inversely related to age, whereas
no significant difference was observed according to sex. With
regard to smoking status, 2.6% of never-smokers, 7.0% of ex-
smokers, and 20.4% of current smokers tried the e-cigarette at
least once. Regular e-cigarette use was 1.2% overall, 1.5%
among
men, and 0.9% among women, and it was highest among young
42. (2.4%) and current smokers (3.7%). Among 36 e-cigarette regu-
lar users, 22.0% did not change their smoking habit, 67.7%
reduced traditional cigarette consumption, and 10.4% quit
smoking.
Conclusions: After fewer than 3 years from the opening of the
first Italian e-cigarette shop, more than 45 million Italians have
heard about e-cigarettes, 3.5 million have tried e-cigaretts, and
more than 600,000 Italians regularly use e-cigarettes. Three out
of 4 e-cigarette users reported to have favorably modified their
smoking habit; however, 90% of users did not quit smoking as a
consequence of starting vaping e-cigarettes. Almost 900,000
Italian never-smokers, particularly young never-smokers, have
tried
this new and potentially addictive product at least once.
intrOdUCtiOn
Approximately, one decade ago, the electronic nicotine delivery
system, also known as electronic cigarette or e-cigarette, was
first introduced into the market in China by the Beijing com-
pany Ruyan (Dawkins, Turner, Roberts, & Soar, 2013; Dockrell,
Morrison, Bauld, & McNeill, 2013; Pauly, Li, & Barry, 2007).
The e-cigarette is a product that allows the inhalation of a
chem-
ical mixture including propylene glycol, nicotine, and flavors
(Kuehn, 2009; Pauly et al., 2007; World Health Organization
[WHO], 2013). Given the shape, the method of inhalation, the
taste, and the possible content of nicotine, the e-cigarette gives
to its consumer (known as “vaper”) a sensation which is similar
to that experienced by inhaling the tobacco smoke of a tradi-
tional cigarette (Sugerman, 2014; WHO, 2013).
Over the last few years, e-cigarette rose in popular-
ity (Ayers, Ribisl, & Brownstein, 2011) and since October
44. 2013). Although there is a broad consensus that e-cigarette
vapor is much less toxic than cigarette smoke (Benowitz
& Goniewicz, 2013), most of the public health experts and
tobacco control activists, the FDA and the WHO itself, warned
the public against this new emerging phenomenon, given (a)
the paucity of clinical studies analyzing safety of the liquid
or the vapor inhaled in the lungs of vapers, (b) the inadequate
evidence that e-cigarettes are effective to let smokers quit or
reduce traditional cigarette consumption, and (c) the lack of
a legislative regulation for this new product (Bains, Agombar,
Clarke, & Patel, 2012; Bauld, 2012; Benowitz & Goniewicz,
2013; Chapman, 2013; Etter, Bullen, Flouris, Laugesen, &
Eissenberg, 2011; Flouris & Oikonomou, 2010; Hampton,
2014; Kuehn, 2009; Pauly et al., 2007; Popova & Ling, 2013;
Sugerman, 2014; WHO, 2013; Yamin, Bitton, & Bates, 2010).
Moreover, various cartridges of e-cigarettes contain a liquid
which substantially vary in the amount of different chemicals,
including nicotine, and purchasers have often no adequate
information to understand the real content and composition
of the refills (Benowitz & Goniewicz, 2013; Cameron et al.,
2013; Cheah, Chong, Tan, Morsed, & Yee, 2012; Flouris &
Oikonomou, 2010; Goniewicz, Kuma, Gawron, Knysak, &
Kosmider, 2013; Trtchounian & Talbot, 2011; WHO, 2013;
Williams & Talbot, 2011). Of concerns is also the fact that fla-
vors can be particularly attractive to adolescents, who could
consequently start e-cigarette use as a gateway to tobacco
smoking (Benowitz & Goniewicz, 2013; Choi, Fabian, Mottey,
Corbett, & Forster, 2012; Hampton, 2014; Sugerman, 2014;
WHO, 2013).
Only a limited number of studies, mostly from the United
States, have been conducted so far to understand awareness,
use,
and harm perception in representative surveys of adults (Pepper
& Brewer, 2013). To our knowledge, within Europe, only one
study on adults from the United Kingdom (Dockrell et al.,
45. 2013),
three studies on smokers from the United Kingdom (Adkison
et al., 2013) and the Czech Republic (Kralikova, Kubatova,
Truneckova, Kmetova, & Hajek, 2012; Kralikova, Novak,
West, Kmetova, & Hajek, 2013), and one study on adolescents
and young adults from Poland (Goniewicz & Zielinska-Danch,
2012) have been published. We therefore fill the knowledge gap
in Italy, a country where smoking prevalence was 20.8% in
2012
(Gallus, Lugo, Colombo, Pacifici, & La Vecchia, 2013), and
where a comprehensive legislation came into force in 2005 to
ban smoking in workplaces and all indoor public places, includ-
ing restaurants and pubs (Gallus et al., 2006).
The objective of the present study is therefore to quan-
tify the proportion of awareness, use, and harm perception of
e-cigarettes using data from a representative population-based
survey conducted in Italy.
MetHOds
Data were collected through a survey on smoking conducted
in Italy during February–May 2013 by DOXA, the Italian
branch of the WIN/GIA (Worldwide Independent Network/
Gallup International Association). The overall sample con-
sisted of 3,000 individuals aged ≥15 years (1,442 men and
1,558 women), representative of the general Italian population
aged 15 years and over (51.1 million inhabitants), in terms of
sex, age, geographic area, and socioeconomic characteristics.
Participants were selected through a representative multi-
stage sampling. The first stage was used to select municipali-
ties (the smallest Italian administrative division) in all of the
20 Italian regions (the largest Italian administrative division)
in order to be representative of the geographic areas sampled.
Thus, taking as criteria two characteristics, region and size of
46. municipality, we identified 116 municipalities, providing a
reproduction of the Italian universe of municipalities (method
known as proportional stratified sample). In the second stage,
in each municipality, an adequate number of electoral wards
was randomly extracted (each ward corresponding to a given
district of the municipalities), so that the various types of more
or less affluent areas of the municipality were represented in
the right proportions (i.e., central and suburban districts, out-
skirts and isolated houses). In the third stage, individuals were
randomly sampled from electoral rolls, within strata defined
by sex and age group, in order to be representative of the
demographic structure of the population. For adolescents aged
15–17 years, we used the same sampling approach for the first
two stages. For the third stage, adolescents, whose names are
not included in the electoral lists, were selected, among neigh-
bors of adult respondents, by means of a “quota” method (by
sex and exact age).
Field substitution was used as the preferred strategy to deal
with nonrespondence (Baldissera et al., 2014). Therefore, non-
respondents, including potential participants refusing to partici-
pate, unavailable (i.e., units nonresponding up to three attempts
of direct contact) and ineligible participants (e.g., hospitalized,
deceased, prisoners or moved away units), were substituted by
their neighbors (living in the same floor/building/street) with
the same sex and age group. In the phase of processing the data,
statistical weights were also generated to balance the sample
with its universe, and therefore to assure representativeness of
the Italian population aged 15 years or over.
Ad hoc trained interviewers conducted interviews in Italian
using a structured questionnaire in the context of a computer-
assisted personal in-house interview. Besides general informa-
tion on sociodemographic characteristics, data were collected
on smoking status (never/ex-/current smokers). Ever smokers
(current and ex-smokers) were participants who had smoked
47. 100 or more cigarettes in their lifetime. Ex-smokers were par-
ticipants who had quit smoking since at least 1 year, and cur-
rent smokers were individuals continuing smoking or having
stopped since less than 1 year. Current smokers were asked
if they had an intention to quit within the next 6 months and
whether they had made at least one quit attempt. Ex-smokers
were asked to report the time since quitting. A specific section
of the questionnaire focused on e-cigarettes. Participants were
asked about their awareness and use of e-cigarettes using the
following single question: “Have you ever heard about e-ciga-
rettes, have you ever tried them or do you have the intention to
try them?” Participants were admitted to answer only one of the
following choices: (a) I have never heard about e-cigarettes; (b)
I heard about e-cigarettes, I have never tried them, and I have
no intention to try them; (c) I heard about e-cigarettes, I have
never tried them, and I have intention to try them; and (d)
I heard about e-cigarettes and I tried them. Participants report-
ing they “have heard about e-cigarettes and have tried them”
were labeled as “ever users” of e-cigarettes. Ever users were
further asked: “Do you regularly use e-cigarettes?” Moreover,
regular e-cigarette users were asked about the features of their
e-cigarettes, including the type of e-cigarette most frequently
1542
nicotine & tobacco research
used, and about the characteristics of use, including the number
of e-cigarettes (sessions of consumption) per day (using the
question: “How many times per day do you use e-cigarettes?”)
and the consequence of e-cigarette use on smoking behavior.
All participants were asked about their opinion (true or false)
on seven different statements concerning e-cigarettes; they (a)
are not harmful for health; (b) are less harmful than traditional
48. cigarettes because they do not contain nicotine; (c) are less
harmful because there is no tobacco combustion; (d) are less
harmful because they contain only nicotine; (e) are more harm-
ful than traditional cigarettes; (f) are an efficient tool to quit
smoking; and (g) allow smoking even where it is forbidden.
Participants were also asked about their attitudes toward the
ban of e-cigarette use in (a) public indoor places (e.g., bars,
restaurants, shops) and (b) on trains (four-item score: strongly
in favor, moderately in favor, moderately against, and strongly
against).
Data Analysis
Multivariate p values for awareness of e-cigarettes and their
regular use were computed through unconditional multiple
logistic regression models adjusted for sex, age, level of educa-
tion, smoking status, and geographic area. Odds ratios (OR)
for use of e-cigarettes (“ever users” vs. “never users”) and the
corresponding 95% confidence intervals (CI) were derived
using the same unconditional multiple logistic regression mod-
els. All the analyses were performed with SAS version 9.2
statistical package (SAS Institute). All the estimates provided
are weighted for statistical weights.
resUlts
Table 1 shows the distribution of 3,000 Italians aged ≥15 years
according to their awareness and use of e-cigarettes. Overall,
8.9% (95% CI = 7.8%–9.9%) of survey participants had never
heard about e-cigarettes, 84.4% (95% CI = 83.1%–85.7%)
had heard about them but had never tried (74.3% without any
intention to try and 10.1% with an intention to try), 5.6% (95%
CI = 4.8%–6.5%) had tried without a regular use, and 1.2%
(95% CI = 0.8%–1.6%; 36 participants) reported a regular use
of e-cigarettes. Men more frequently heard about e-cigarettes
49. (94.8%) than women (87.8%; multivariate p < .001). Awareness
of e-cigarettes increased with decreasing age (p for trend <
.001) and increasing level of education (p for trend < .001).
Compared to never-smokers (89.0%), awareness of e-cigarettes
was significantly higher among current (96.0%; p = .002) and
ex-smokers (94.3%; p = .004). Compared to southern Italy
(88.7%), awareness of e-cigarettes was significantly higher in
northern (92.1%; p = .004) and central Italy (93.1%; p = .004).
Regular e-cigarette use was similar in men (1.5%) and
women (0.9%; multivariate p = .910) and in various categories
of education (p for trend = .504). E-cigarettes were more fre-
quently used by the young (prevalence of regular use was 2.4%
in 15–24 years old individuals, 1.6% in 25–44, 1.0% in 45–64
table 1. Awareness and Use of E-cigarettes on the Overall
Samplea, by Selected Characteristics: Italy 2013
Awareness of e-cigarettes (%)b
N
No awareness of
e-cigarettes (%)b
Never tried without
intention to try
Never tried with
intention to try
Tried but no
regular use Regular use
Total 3,000 8.9 74.3 10.1 5.6 1.2
Sex
Men 1,442 5.2 74.6 11.8 6.9 1.5
50. Women 1,558 12.2 73.9 8.5 4.5 0.9
Age (years)
15–24 349 5.2 70.9 12.3 9.2 2.4
25–44 994 4.6 74.2 13.0 6.7 1.6
45–64 948 5.2 77.0 10.4 6.5 1.0
≥65 709 21.6 72.4 4.4 1.3 0.3
Level of education
Low 1,193 15.9 72.1 7.8 3.2 1.0
Intermediate 1,362 4.2 73.8 11.8 8.6 1.6
High 445 4.1 81.4 11.0 3.1 0.5
Smoking status
Never-smoker 1,992 11.0 80.3 6.1 2.5 0.1
Ex-smoker 392 5.7 82.7 4.6 4.3 2.8
Current smoker 616 4.0 49.3 26.3 16.6 3.7
Geographic area
Northern Italy 1,380 7.9 74.9 10.2 6.0 0.9
Central Italy 596 6.9 76.6 11.5 4.7 0.3
Southern Italy and islands 1,024 11.3 72.0 9.0 5.6 2.1
aSample of 3,000 Italians aged ≥15 years, representative of the
general Italian population in terms of sex, age, geographic
area, and socioeconomic characteristics. All the estimates in
the table were derived using statistical weights to reassure
sample
representativeness.
bRow percentages.
1543
e-cigarette awareness, use, and harm perceptions in italy
and 0.3% in ≥65 year old adults; p for trend = .001). Compared
to never-smokers (0.1%), regular use of e-cigarette was higher
in current (3.7%; p < .001) and ex-smokers (2.8%; p < .001),
51. while, compared to central Italy (0.3%), regular use was higher
in southern Italy (2.1%; p = .018) and similar in northern Italy
(0.9%; p = .132).
Among 36 regular users, 95.5% reported to use e-cigarettes
with nicotine and only 4.5% used e-cigarettes with vapor and
flavors only (without nicotine). Regular users reported to use
e-cigarettes from 1 to 70 times per day (mean: 10.0 overall,
10.8 among men and 8.7 among women). As a consequence of
starting using e-cigarettes, 78.0% of regular users reported to
have modified their smoking behavior, 67.7% having reduced
traditional cigarette consumption and 10.4% having quit smok-
ing (Table 2).
Table 3 shows the distribution of participants by lifetime
use of e-cigarettes (“ever users” vs. “never users”) according to
selected characteristics, overall and among current smokers.
The
proportion of participants reporting to have ever tried e-
cigarettes
was 6.8% (95% CI = 5.9%–7.7%; n = 205). E-cigarette trial was
inversely related to age, the ORs compared to participants aged
15–24 years being 0.56 for 25–44, 0.49 for 45–64, and 0.16 for
≥65 years (p for trend < .001). Individuals with intermediate
compared to low education reported to have tried e-cigarettes
more frequently (OR = 1.91), whereas no significant difference
was observed according to sex and geographic area. Overall,
2.6% (95% CI = 1.9%–3.3%; n = 52) of never-smokers, 7.0%
(95% CI = 4.5%–9.6%; n = 28) of ex-smokers, and 20.4% (95%
CI = 17.2%–23.6%; n = 126) of current smokers tried at least
once
e-cigarettes. Compared to never-smokers, the OR for ex-
smokers
was 3.79 and that of current smokers was 9.20. The pattern of
cur-
rent smokers largely reflects that of the overall population.
52. Trial of e-cigarettes was more common in current smokers
with an intention to quit smoking within the following 6 months
(36.0%), compared to those with no plans to quit (15.5%; p <
.001) and in smokers who had made at least one quit attempt
(29.3%) compared to those who had not made a quit attempt
(16.5%; p < .001). Among ex-smokers who tried the e-ciga-
rette, 92.6% had quit smoking in the previous 3 years.
The majority of Italians believe that e-cigarettes allow smok-
ing even where it is forbidden (71.9%), they are less harmful
than traditional cigarettes since there is no tobacco combustion
(64.7%) and they are a useful tool to quit smoking (57.3%).
Overall, 47.7% of Italians believe that e-cigarettes are less
harmful because they contain only nicotine, 32.4% that they
are not harmful for health, but 23.1% that they are more harm-
ful than traditional cigarettes. Similar patterns were observed
according to different smoking status.
Figure 1 shows the prevalence of participants who moder-
ately or strongly support banning e-cigarettes in public places.
The proportion of Italians aged ≥15 years in favor of a com-
plete ban of e-cigarette use in public indoor places (including
bars, restaurants, and shops) was 64.8% overall, 70.4% among
never-smokers, 60.0% among ex-smokers, and 50.4% among
current smokers. The prevalence of participants supporting the
ban of e-cigarettes on trains was 64.0% overall, 69.4% among
never-smokers, 59.9% among ex-smokers, and 49.7% among
current smokers. After exclusion of the few participants who
were unaware of e-cigarettes, estimates on perceptions and atti-
tudes did not substantially change.
disCUssiOn
According to this representative sample, more than 45 million
Italians (91.1% of Italians aged ≥15 years) have heard about the
53. e-cigarettes, 3.5 million (6.8%) have already tried, and more
than 600,000 Italians (1.2%) regularly use it.
According to awareness, in Italy, we found the highest pro-
portion of the adult population having heard about e-cigarettes
(Pepper & Brewer, 2013). This may be due in part to a time
effect, but certainly also to the persistent promotion of e-cig-
arettes on several media in Italy. Our proportion among cur-
rent smokers (96%) was similar only to that observed among
smokers in the Czech Republic in 2012 (97%) (Kralikova et al.,
2013). All the studies providing data on the trend of awareness
of e-cigarettes systematically showed a substantial increase
with calendar period. Thus, in the United States, the number of
table 2. Characteristic of Regular E-cigarettes Users: Italy 2013
Total
N % (95% CI)
36 100.0
Type of e-cigarette most frequently used
With nicotine 34 95.5 (87.7–100.0)
Only vapor (without nicotine) 0 0.0
Vapor and flavor (without nicotine) 2 4.5 (0.0–11.3)
Number of e-cigarettes per day
<5 10 27.4 (12.8–42.0)
5–14 19 54.5 (38.2–70.9)
≥15 7 18.1 (5.5–30.7)
Consequences on smoking behaviors
Started smoking manufactured cigarettes
(from never-smoker to current smoker)
0 0.0
54. Did not change my smoking habit 8 22.0 (8.4–35.6)
Slightly reduced number of cigarettes smoked per day 16 44.5
(28.1–60.8)
Drastically reduced number of cigarettes smoked per day 8 23.2
(9.3–37.0)
Quitted smoking 4 10.4 (0.4–20.4)
Note. CI = confidence interval.
1544
nicotine & tobacco research
adults having heard about e-cigarettes doubled between 2009
(16%) and 2010 (32%) (Regan, Promoff, Dube, & Arrazola,
2013) and markedly increased between 2010 (40%) and 2011
(58%) (King, Alam, Promoff, Arrazola, & Dube, 2013). In
the United Kingdom, smokers who heard about e-cigarettes
increased from 60% in 2010 to 77% in 2012 (Dockrell et al.,
2013). Also in Italy, we observe such a trend. In fact, awareness
of e-cigarettes was 72% among current and ex-smokers in a
companion survey conducted by DOXA in 2012 (Gallus et al.,
2013; OSSFAD, 2012). This estimate increased to more than
95% among ever smokers in 2013. In our study, awareness of
e-cigarette was highest among current smokers, men, young-
est, and highly educated subjects. This is in broad agreement
with previous studies (Adkison et al., 2013; Choi & Forster,
2013; King et al., 2013; Regan et al., 2013).
Ever use of e-cigarette also substantially increased in Italy
in 1 year only. In fact, ever smokers having tried e-cigarettes
were 7.3% in 2012 (OSSFAD, 2012) and 15.2% in 2013. In
agreement with several other studies (Adkison et al., 2013;
55. Choi & Forster, 2013; Pearson, Richardson, Niaura, Vallone,
table 3. Distribution of the Overall Sample and the Sample of
Current Smokers by Lifetime Use of E-Cigarettes
(Ever vs. Never Users), by Selected Characteristics: Italy 2013
Overall sample Current smokers
E-cigarette use, N (%)a ORb for e-cigarette ever
users vs. never
users (95% CI)
E-cigarette use, N (%)a ORb for e-cigarette
ever users vs. never
users (95% CI)Ever users Never users Ever users Never users
Total 205 (6.8) 2795 (93.2) – 126 (20.4) 491 (79.6) –
Sex
Men 121 (8.4) 1321 (91.6) 1c 76 (20.2) 301 (79.8) 1c
Women 84 (5.4) 1475 (94.6) 0.89 (0.65–1.22) 49 (20.6) 190
(79.4) 0.96 (0.64–1.45)
Age (years)
15–24 40 (11.6) 309 (88.4) 1c 23 (32.6) 48 (67.4) 1c
25–44 82 (8.2) 912 (91.8) 0.56 (0.36–0.86) 49 (20.3) 194
(79.8) 0.55 (0.30–0.99)
45–64 71 (7.5) 877 (92.5) 0.49 (0.31–0.78) 47 (20.4) 184
(79.6) 0.59 (0.32–1.08)
≥65 11 (1.6) 698 (98.4) 0.16 (0.08–0.33) 6 (8.7) 65 (91.4) 0.26
(0.10–0.72)
Level of education
Low 50 (4.2) 1143 (95.8) 1c 35 (15.1) 198 (84.9) 1c
Intermediate 139 (10.2) 1223 (89.8) 1.95 (1.35–2.81) 77 (25.0)
56. 230 (75.0) 1.70 (1.06–2.73)
High 16 (3.6) 429 (96.4) 0.71 (0.39–1.29) 14 (17.9) 63 (82.1)
1.15 (0.57–2.34)
Smoking status
Never-smokers 52 (2.6) 1940 (97.4) 1c
Ex-smokers 28 (7.0) 365 (93.0) 3.79 (2.30–6.27)
Current smokers 126 (20.4) 491 (79.6) 9.20 (6.47–13.07)
Geographic area
Northern Italy 94 (7.0) 1283 (93.0) 1c 55 (19.7) 225 (80.3) 1c
Central Italy 30 (5.0) 566 (95.0) 0.68 (0.43–1.06) 18 (14.8) 104
(85.2) 0.69 (0.38–1.24)
Southern Italy and islands 78 (7.7) 946 (92.3) 1.07 (0.76–1.49)
52 (24.4) 162 (75.6) 1.33 (0.85–2.06)
Note. OR = odds ratio; CI = confidence interval.
aRow percentages.
bORs were estimated using unconditional multiple logistic
regression models after adjustment for sex, age, level of
education,
smoking status, and geographic area.
cReference category.
Figure 1. Percent distribution and corresponding 95%
confidence interval of never, current, and ex-smokers according
to support
of a ban of e-cigarettes in selected areas (Italy 2013). Overall,
14% to 17% of subjects had no opinion on the statements and
were
therefore excluded by the present analysis.
1545
57. e-cigarette awareness, use, and harm perceptions in italy
& Abrams, 2012; Popova & Ling, 2013), we observed a higher
prevalence of e-cigarette users among the youngest age group,
where 11.6% had tried at least once an e-cigarette. Of concern
is also the non-negligible proportion of adolescents having tried
the e-cigarette in our sample (7.4%; 95% CI = 2.2%–12.6%,
based on 99 adolescents aged 15–17 years). We found more-
over that e-cigarette users had most frequently an intermedi-
ate level of education, in line with a U.S. study (McMillen,
Maduka, & Winickoff, 2012). Current smokers with an inten-
tion to quit within the next 6 months more frequently reported
e-cigarette use, in agreement with one study from the United
States (Pearson et al., 2012). However, at least other three stud-
ies did not find any relation between e-cigarette use and inten-
tion to quit tobacco smoking (Adkison et al., 2013; Popova &
Ling, 2013; Sutfin, McCoy, Morrell, Hoeppner, & Wolfson,
2013).
Our study adds knowledge on the harm perception of the
Italian adult population; while the majority of Italians (65%)
believe that e-cigarettes are less harmful than traditional cig-
arettes because of the lack of tobacco combustion in e-ciga-
rette, 23% of adults still believe that e-cigarettes may be even
more harmful than traditional ones. Finally, the large majority
of Italians, but also half of current smokers, are favorable to
ban e-cigarettes not only on trains, where a regulation ban-
ning smoking only in selected wagons is available since 1975
(Legge 584, 1975), but also in all indoor public places, regu-
lated by a total ban since 2005 (Gallus et al., 2006).
A limitation of the present survey is the relatively small
number of e-cigarette users, which makes estimates unstable.
Another limitation is that the questionnaire on e-cigarettes was
not validated, and some questions on regular use, intensity
of use of e-cigarettes, and its consequences on smoking sta-
58. tus may have been misinterpreted by survey participants. The
strengths of this study include the face-to-face survey design
and the national representativeness of the sample.
In conclusion, we observe a diffuse awareness of e-ciga-
rette—and an increasing diffusion of its use as well—in Italy
in less than 3 years from the constitution of the first Italian
shop selling e-cigarettes. On the one hand, our data suggest that
e-cigarettes may be an alternative to tobacco smoking, since
three out of four users reported to have favorably modified
their smoking habit (68% reduced smoking consumption and
10% quitted smoking completely) after starting e-cigarette use.
On the other hand, 90% of e-cigarette users did not quit smok-
ing as a consequence of starting vaping e-cigarettes, and the
majority of e-cigarette users remain therefore current smok-
ers. This raises concerns on dual use, since decreasing cigarette
consumption confers clearly less health benefit than quitting
smoking completely (Chapman, 2013). More importantly,
almost 900,000 Italian never smokers, particularly the young,
have tried at least once this new and potentially addictive
product. This suggests that e-cigarette use may be a gateway
to nicotine addiction and consequently to tobacco smoking
(Benowitz & Goniewicz, 2013; Choi et al., 2012; WHO, 2013).
There is substantial heterogeneity in the composition of
various types of e-cigarettes (Benowitz & Goniewicz, 2013;
Cameron et al., 2013; Cheah et al., 2012; Flouris & Oikonomou,
2010; Goniewicz, Kuma, et al., 2013; Trtchounian & Talbot,
2011; WHO, 2013; Williams & Talbot, 2011), and each of these
should be monitored on a toxicological and, in principle, epi-
demiological level. In particular, the release of nicotine tends
to be limited by e-cigarettes but is highly variable (Cameron
et al., 2013; Cheah et al., 2012). Flavors may also release toxic
substances, but no adequate data have been published to date.
More in general, there is a broad issue of safety and of effi-
59. cacy also in comparative terms with other nicotine releasing
devices (chewing gums, patches). A randomized clinical trial
administered to quantify the efficacy of e-cigarette to support
smoking cessation was conducted in New Zealand (Bullen
et al., 2013). Randomizing 657 smokers to (a) e-cigarette with
nicotine, (b) nicotine patch, and (c) e-cigarette without nicotine
(placebo), no significant differences in smoking cessation rates
at 6 months were observed among the three groups. Cessation
rates were 7.3% among users of e-cigarette, 5.8% among those
with nicotine patch, and 4.1% among placebo users (Bullen
et al., 2013; Hampton, 2014). At least other two population-
based longitudinal studies showed that e-cigarettes have no
effect on smoking cessation (Grana, Popova, & Ling, 2014;
Vickerman, Carpenter, Altman, Nash, & Zbikowski, 2013).
Despite the increasing number of studies on e-cigarettes
(Bullen et al., 2010; 2013; Caponnetto et al., 2013; Chen,
2013; Goniewicz, Knysak et al., 2013; Pellegrino et al., 2012;
Siegel, Tanwar, & Wood, 2011; Vardavas et al., 2012;
Williams,
Villarreal, Bozhilov, Lin, & Talbot, 2013; Zhang, Sumner, &
Chen, 2013), questions raised over 5 years ago (Pauly et al.,
2007) on the safety of the e-cigarette use and the efficacy of the
e-cigarette as a substitute to tobacco smoking have not been
adequately elucidated, yet. Only providing answers to those
questions it will be possible to understand any risk-benefit bal-
ance of e-cigarette on a population level.
FUnding
The work of SG and CLV was partially supported by the Italian
League Against Cancer (Milan) and the Italian Foundation for
Cancer Research (FIRC).
deClaratiOn OF interests
60. None declared.
aCknOwledgMents
The survey was conducted with the contribution of the Italian
Ministry of Health.
reFerenCes
Adkison, S. E., O’Connor, R. J., Bansal-Travers, M., Hyland,
A., Borland, R., Yong, H. H., … Fong, G. T. (2013).
Electronic nicotine delivery systems: International tobacco
control four-country survey. American Journal of Preventive
Medicine, 44, 207–215. doi:10.1016/j.amepre.2012.10.018
Ayers, J. W., Ribisl, K. M., & Brownstein, J. S. (2011).
Tracking the rise in popularity of electronic nicotine deliv-
ery systems (electronic cigarettes) using search query sur-
veillance. American Journal of Preventive Medicine, 40,
448–453. doi:10.1016/j.amepre.2010.12.007
Bains, M., Agombar, H., Clarke, E., & Patel, R. (2012). Time
for NHS policy on electronic cigarettes. British Medical
Journal, 345, e6587. doi:10.1136/bmj.e6587
Baldissera, S., Ferrante, G., Quarchioni, E., Minardi, V.,
Possenti, V., Carrozzi, G., … Salmaso, S. (2014). Field
substitution of nonresponders can maintain sample size
1546
nicotine & tobacco research
and structure without altering survey estimates - The expe-
61. rience of the Italian behavioral risk factors surveillance
system (PASSI). Annals of Epidemiology, 24, 241–245.
doi:10.1016/j.annepidem.2013.12.003
Bauld, L. (2012). Commentary on Wagener et al. (2012):
E-cigarettes: Room for cautious optimism. Addiction, 107,
1549–1550. doi:10.1111/j.1360-0443.2012.03904.x
Benowitz, N. L., & Goniewicz, M. L. (2013). The regulatory
chal-
lenge of electronic cigarettes. Journal of the American Medical
Association, 310, 685–686. doi:10.1001/jama.2013.109501
Borland, R. (2011). Electronic cigarettes as a method of tobacco
control. British Medical Journal, 343, d6269. doi:10.1136/
bmj.d6269
Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V.,
Williman, J., & Walker, N. (2013). Electronic cigarettes for
smoking cessation: A randomised controlled trial. Lancet,
382, 1629–1637. doi:10.1016/S0140-6736(13)61842-5
Bullen, C., McRobbie, H., Thornley, S., Glover, M., Lin, R.,
& Laugesen, M. (2010). Effect of an electronic nicotine
delivery device (e-cigarette) on desire to smoke and with-
drawal, user preferences and nicotine delivery: Randomised
cross-over trial. Tobacco Control, 19, 98–103. doi:10.1136/
tc.2009.031567
Cameron, J. M., Howell, D. N., White, J. R., Andrenyak, D. M.,
Layton, M. E., & Roll, J. M. (2013). Variable and potentially
fatal amounts of nicotine in e-cigarette nicotine solutions.
Tobacco Control. doi:10.1136/tobaccocontrol-2012-050604
Caponnetto, P., Campagna, D., Cibella, F., Morjaria, J. B.,
Caruso, M., Russo, C., & Polosa, R. (2013). EffiCiency and
62. Safety of an eLectronic cigAreTte (ECLAT) as tobacco ciga-
rettes substitute: A prospective 12-month randomized con-
trol design study. PLoS One, 8, e66317. doi:10.1371/journal.
pone.0066317
Chapman, S. (2013). Should electronic cigarettes be as freely
available as tobacco cigarettes? No. British Medical Journal,
346, f3840. doi:10.1136/bmj.f3840
Cheah, N. P., Chong, N. W., Tan, J., Morsed, F. A., & Yee, S.
K.
(2012). Electronic nicotine delivery systems: regulatory and
safety challenges: Singapore perspective. Tobacco Control,
23, 119–125. doi:10.1136/tobaccocontrol-2012-050483
Chen, I. L. (2013). FDA summary of adverse events on elec-
tronic cigarettes. Nicotine and Tobacco Research, 15, 615–
616. doi:10.1093/ntr/nts145
Choi, K., Fabian, L., Mottey, N., Corbett, A., & Forster, J.
(2012). Young adults’ favorable perceptions of snus, dis-
solvable tobacco products, and electronic cigarettes:
Findings from a focus group study. American Journal
of Preventive Medicine, 102, 2088–2093. doi:10.2105/
AJPH.2011.300525
Choi, K., & Forster, J. (2013). Characteristics associated with
awareness, perceptions, and use of electronic nicotine deliv-
ery systems among young US Midwestern adults. American
Journal of Preventive Medicine, 103, 556–561. doi:10.2105/
AJPH.2012.300947
Dawkins, L., Turner, J., Roberts, A., & Soar, K. (2013).
‘Vaping’ profiles and preferences: An online survey of
electronic cigarette users. Addiction, 108, 1115–1125.
doi:10.1111/add.12150
63. Dockrell, M., Morrison, R., Bauld, L., & McNeill, A. (2013).
E-Cigarettes: Prevalence and attitudes in Great Britain. Nicotine
and Tobacco Research, 15, 1737–1744. doi:10.1093/ntr/ntt057
Etter, J. F. (2013). Should electronic cigarettes be as freely
available as tobacco? Yes. British Medical Journal, 346,
f3845. doi:10.1136/bmj.f3845
Etter, J. F., Bullen, C., Flouris, A. D., Laugesen, M., &
Eissenberg, T. (2011). Electronic nicotine delivery sys-
tems: A research agenda. Tobacco Control, 20, 243–248.
doi:10.1136/tc.2010.042168
Flouris, A. D., & Oikonomou, D. N. (2010). Electronic ciga-
rettes: Miracle or menace? British Medical Journal, 340,
c311. doi:10.1136/bmj.c311
Gallus, S., Lugo, A., Colombo, P., Pacifici, R., & La Vecchia,
C. (2013). Smoking prevalence in Italy 2011 and 2012, with
a focus on hand-rolled cigarettes. Preventive Medicine, 56,
314–318. doi:10.1016/j.ypmed.2013.02.009
Gallus, S., Zuccaro, P., Colombo, P., Apolone, G., Pacifici, R.,
Garattini, S., & La Vecchia, C. (2006). Effects of new smok-
ing regulations in Italy. Annals of Oncology, 17, 346–347.
doi:10.1093/annonc/mdj070
Goniewicz, M. L., Knysak, J., Gawron, M., Kosmider, L.,
Sobczak, A., Kurek, J., … Benowitz, N. (2013). Levels of
selected carcinogens and toxicants in vapour from electronic
cigarettes. Tobacco Control, 23, 133–139. doi:10.1136/
tobaccocontrol-2012–050859
Goniewicz, M. L., Kuma, T., Gawron, M., Knysak, J., &
Kosmider, L. (2013). Nicotine levels in electronic cigarettes.
64. Nicotine and Tobacco Research, 15, 158–166. doi:10.1093/
ntr/nts103
Goniewicz, M. L., & Zielinska-Danch, W. (2012).
Electronic cigarette use among teenagers and young
adults in Poland. Pediatrics, 130, e879–885. doi:10.1542/
peds.2011-3448
Grana, R. A., Popova, L., & Ling, P. M. (2014). A longitudi-
nal analysis of electronic cigarette use and smoking cessa-
tion. JAMA Internal Medicine, 174, 812–813. doi:10.1001/
jamainternmed.2014.187
Hampton, T. (2014). Experts call for research plus regulation of
e-cigarettes. Journal of the American Medical Association,
311, 123–124. doi:10.1001/jama.2013.285292
King, B. A., Alam, S., Promoff, G., Arrazola, R., & Dube, S.
R. (2013). Awareness and ever use of electronic cigarettes
among U.S. adults, 2010–2011. Nicotine and Tobacco
Research, 15, 1623–1627. doi:10.1093/ntr/ntt013
Kralikova, E., Kubatova, S., Truneckova, K., Kmetova, A., &
Hajek, P. (2012). The electronic cigarette: What proportion of
smokers have tried it and how many use it regularly? Addiction,
107, 1528–1529. doi:10.1111/j.1360-0443.2012.03916.x
Kralikova, E., Novak, J., West, O., Kmetova, A., & Hajek, P.
(2013). Do e-cigarettes have the potential to compete with
conventional cigarettes? A survey of conventional cigarette
smokers’ experiences with e-cigarettes. Chest, 144, 1609–
1614. doi:10.1378/chest.12-2842
Kuehn, B. M. (2009). FDA: Electronic cigarettes may be risky.
Journal of the American Medical Association, 302, 937.
doi:10.1001/jama.2009.1245
65. Legge 584. (1975). Divieto di fumare in determinati locali e
su mezzi di trasporto pubblico. Gazzetta Ufficiale n. 322.
Retrieved from May 13, 2014, www.normattiva.it/ricerca/
semplice
McMillen, R., Maduka, J., & Winickoff, J. (2012). Use of
emerging tobacco products in the United States. Journal
of Environmental and Public Health, 2012, 989474.
doi:10.1155/2012/989474
OSSFAD. (2012). DOXA: Il fumo in Italia. Retrieved from
December 10, 2013, www.iss.it/binary/fumo4/cont/
Indagine_DOXA2012.pdf
Pauly, J., Li, Q., & Barry, M. B. (2007). Tobacco-free
electronic
cigarettes and cigars deliver nicotine and generate concern.
Tobacco Control, 16, 357. doi:10.1136/tc.2006.019687
Pearson, J. L., Richardson, A., Niaura, R. S., Vallone, D. M.,
& Abrams, D. B. (2012). e-Cigarette awareness, use, and
harm perceptions in US adults. American Journal of Public
Health, 102, 1758–1766. doi:10.2105/AJPH.2011.300526
Pellegrino, R. M., Tinghino, B., Mangiaracina, G., Marani,
A., Vitali, M., Protano, C., … Cattaruzza, M. S. (2012).
Electronic cigarettes: An evaluation of exposure to
1547
e-cigarette awareness, use, and harm perceptions in italy
chemicals and fine particulate matter (PM). Annali di Igiene,
66. 24, 279–288.
Pepper, J. K., & Brewer, N. T. (2013). Electronic nicotine
deliv-
ery system (electronic cigarette) awareness, use, reactions
and beliefs: A systematic review. Tobacco Control. [Epub
ahead of print]. doi:10.1136/tobaccocontrol-2013-051122
Popova, L., & Ling, P. M. (2013). Alternative tobacco prod-
uct use and smoking cessation: A national study. American
Journal of Public Health, 103, 923–930. doi:10.2105/
AJPH.2012.301070
Regan, A. K., Promoff, G., Dube, S. R., & Arrazola, R. (2013).
Electronic nicotine delivery systems: Adult use and aware-
ness of the ‘e-cigarette’ in the USA. Tobacco Control, 22,
19–23. doi:10.1136/tobaccocontrol-2011-050044
Richardson, A., Ganz, O., Stalgaitis, C., Abrams, D., &
Vallone,
D. (2014). Noncombustible tobacco product advertising:
How companies are selling the new face of tobacco. Nicotine
and Tobacco Research, 16, 606–614. doi:10.1093/ntr/ntt200
Richardson, A., Ganz, O., & Vallone, D. (2014). Tobacco on
the web: Surveillance and characterisation of online tobacco
and e-cigarette advertising. Tobacco Control. [Epub ahead of
print]. doi:10.1136/tobaccocontrol-2013-051246
Siegel, M. B., Tanwar, K. L., & Wood, K. S. (2011). Electronic
cigarettes as a smoking-cessation: Tool results from an
online survey. American Journal of Preventive Medicine, 40,
472–475. doi:10.1016/j.amepre.2010.12.006
Sugerman, D. T. (2014). JAMA patient page. e-Cigarettes.
Journal of the American Medical Association, 311, 212.
67. doi:10.1001/jama.2013.279164
Sutfin, E. L., McCoy, T. P., Morrell, H. E., Hoeppner, B. B.,
& Wolfson, M. (2013). Electronic cigarette use by college
students. Drug and Alcohol Dependence, 131, 214–221.
doi:10.1016/j.drugalcdep.2013.05.001
Trtchounian, A., & Talbot, P. (2011). Electronic nicotine deliv-
ery systems: Is there a need for regulation? Tobacco Control,
20, 47–52. doi:10.1136/tc.2010.037259
Vardavas, C. I., Anagnostopoulos, N., Kougias, M.,
Evangelopoulou, V., Connolly, G. N., & Behrakis, P. K.
(2012). Short-term pulmonary effects of using an electronic
cigarette: Impact on respiratory flow resistance, imped-
ance, and exhaled nitric oxide. Chest, 141, 1400–1406.
doi:10.1378/chest.11–2443
Vickerman, K. A., Carpenter, K. M., Altman, T., Nash, C. M.,
& Zbikowski, S. M. (2013). Use of electronic cigarettes
among state tobacco cessation quitline callers. Nicotine and
Tobacco Research, 15, 1787–1791. doi:10.1093/ntr/ntt061
Wagener, T. L., Siegel, M., & Borrelli, B. (2012). Electronic
cigarettes: Achieving a balanced perspective. Addiction, 107,
1545–1548. doi:10.1111/j.1360-0443.2012.03826.x
Williams, M., & Talbot, P. (2011). Variability among electronic
cigarettes in the pressure drop, airflow rate, and aerosol pro-
duction. Nicotine and Tobacco Research, 13, 1276–1283.
doi:10.1093/ntr/ntr164
Williams, M., Villarreal, A., Bozhilov, K., Lin, S., & Talbot,
P. (2013). Metal and silicate particles including nanopar-
ticles are present in electronic cigarette cartomizer fluid
and aerosol. PLoS One, 8, e57987. doi:10.1371/journal.
68. pone.0057987
World Health Organization (WHO). (2013). Questions and
answers on electronic cigarettes or electronic nicotine deliv-
ery systems (ENDS). Tobacco Free Initiative. Retrieved
from December 10, 2013, www.who.int/tobacco/communi-
cations/statements/eletronic_cigarettes/en/index.html
Yamin, C. K., Bitton, A., & Bates, D. W. (2010).
E-cigarettes: A rapidly growing Internet phenom-
enon. Annals of Internal Medicine, 153, 607–609.
doi:10.7326/0003-4819-153-9-201011020-00011
Zhang, Y., Sumner, W., & Chen, D. R. (2013). In vitro particle
size distributions in electronic and conventional cigarette
aerosols suggest comparable deposition patterns. Nicotine
and Tobacco Research, 15, 501–508. doi:10.1093/ntr/
nts165
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Am J Health Behav.™ 2015;39(3):361-371 361
69. T
here is an upsurge in tobacco industry ad-
vertising to encourage cigarette smokers to
use electronic cigarettes (e-cigarettes) in no-
smoking areas and as an aid to smoking cessation.
E-cigarettes are devices that include a battery-pow-
ered heating element designed to heat and aerosol-
ize liquids containing varying levels of nicotine, fla-
voring agents, a number of unknown components,
and in some cases tobacco itself.1 Aerosolized nic-
otine in e-cigarettes contains glycerine to mimic
smoke of conventional cigarettes while supposedly
delivering lower toxin levels than those found in a
conventional cigarette.2-5 Vaporizers (or vape-pens)
are similar to e-cigarettes, but typically contain a
larger battery with variable heat settings to heat a
refillable tank with a wick for liquid nicotine or a
compartment for vaporizing THC oil or even can-
nabis buds. Vaporizers are more expensive than e-
cigarettes, and their higher heat levels can deliver
a larger dose of nicotine vapor. The nicotine can be
purchased in varying concentrations and flavors.
There is a dearth of information on the perceptions
and use of e-cigarettes among older adults.
Prevalence and Impact of Smoking in Older
Adults
Older smokers initiated smoking when it was
ubiquitous and they were most impacted by indoor
smoking bans. Disparities in tobacco use among
adults continue to exist by race/ethnicity, educa-
tion, income, and mental health status.6 In the last
decade, smoking prevalence has declined in all age
70. groups in the US except for older smokers. In fact,
smoking prevalence for adults over 65 actually has
increased. In 2011, smoking prevalence for 45-
64 year-olds was 19.5%, higher than the national
average of 18%.7 These statistics reflect both the
marginalization of older smokers by society and
tobacco research funding,8 and the fact that older
smokers are targeted by an aggressive tobacco in-
dustry.9 Older smokers frequently face economic
and social disadvantages; yet, they are often ig-
nored in discussions of marginalized populations
impacted by tobacco.10-13
Because older smokers underestimate both the
risks of smoking and the benefits of cessation, they
are the least likely to quit of any age group.13 Older
adults have the greatest smoking related health
burden.14 However, quitting smoking, at any age,
decreases cardiovascular risk and provides sig-
nificant health benefits and quitting by age 50 re-
duces the risk of lung cancer by half.15 Yet, older
adults (45-64 year-olds) are often unaware of these
benefits.16 A primary reason for these mispercep-
Janine K. Cataldo, Associate Professor, University of Cali-
fornia, San Francisco School of Nursing, San Francisco, CA.
Anne Berit Petersen, Doctoral Candidate, University of Cali-
fornia, San Francisco School of Nursing, San Francisco, CA.
Mary Hunter, Doctoral Student, University of California, San
Francisco School of Nursing, San Francisco, CA. Julie Wang,
Postdoctoral Fellow, University of California, San Francisco,
Center of Tobacco Control, Research, and Education, San
Francisco, CA. Nicolas Sheon, University of California, San
Francisco, Department of Medicine, San Francisco, CA.
Correspondence Dr Cataldo; [email protected]
E-cigarette Marketing and Older Smokers:
71. Road to Renormalization
Janine K. Cataldo, RN, PhD, FAAN; Anne Berit Petersen, RN,
MS, MPH; Mary Hunter, MN;
Julie Wang, MPH, PhD; Nicolas Sheon, PhD
Objectives: To describe older smokers’
perceptions of risks and use of e-cigarettes,
and their responses to marketing and
knowledge of, and opinions about, regula-
tion of e-cigarettes. Methods: Eight 90-min-
ute focus groups with 8 to 9 participants
met in urban and suburban California to
discuss topics related to cigarettes and al-
ternative tobacco products. Results: Older
adults are using e-cigarettes for cessation
and as a way to circumvent no-smoking
policies; they have false perceptions about
the effectiveness and safety of e-cigarettes.
They perceive e-cigarette marketing as a
way to renormalize smoking. Conclusions:
To stem the current epidemic of nicotine
addiction, the FDA must take immediate
action because e-cigarette advertising pro-
motes dual use and may contribute to the
renormalization of smoking.
Key words: older smokers; e-cigarettes;
marketing; perception; use
Am J Health Behav. 2015;39(3):361-371
DOI: http://dx.doi.org/10.5993/AJHB.39.3.9
72. E-cigarette Marketing and Older Smokers: Road to
Renormalization
362
tions is the tobacco industry’s aggressive targeting
of older smokers8 in the marketing of both con-
ventional and emerging tobacco products, such
as e-cigarettes and vaporizers.17-19 Tobacco com-
panies encourage tobacco use through marketing
that reduces perceptions of harm associated with
tobacco use and increases perceptions of social ac-
ceptability.20-22 Previous analyses have shown that
the tobacco industry has targeted older adults and
marketed “light” and “low-tar” cigarettes as alter-
natives to quitting with the false implication that
they were healthier choices.8 Using a similar strat-
egy, the tobacco industry has expanded its adver-
tising of smokeless tobacco and e-cigarettes as
alternative products for use in no-smoking areas
and as aides to decrease smoking.23,24
The Emergence of E-cigarette Use in Older
Adults
In the US, the prevalence of e-cigarette use is
rising; in one study, 3.3% of adults in 2010 and
6.2% in 2011 had ever used an e-cigarette.25 In ad-
dition, awareness of these products among adults
increased from 40.9% in 2010 to 57.9% in 2011.25
Current cigarette smokers are more likely to use
e-cigarettes than former or never smokers25 and in
2012, 76.3% of current e-cigarette users reported
concurrent use of conventional cigarettes.26-29